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Employer
1050 Ironpigs Way, Allentown, PA 18109 · EIN 26-1675014 · Dec 1, 2024 to Nov 30, 2025
Plan year 2024
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Schedule A
Coverage contracts on the filing. If the carrier did not provide Schedule A, the row is listed with that note.
Visible subtotal $4,454
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | — | Comp not disclosed Premium $13,217 |
| Stop-loss | Crum & Forster | — | 33 | Comp not disclosed Premium $125,169 |
| Dental | United Concordia Insurance Company | The Benecon Group, Inc. | 56 | $2,273 13.8% of $16,506 |
| Vision | Capital Advantage Assurance Company | Bsi Corporate Benefits, Inc. | 48 | $81 5.0% of $1,613 |
| Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 41 | $603 17.5% of $3,454 |
| AD&D | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 9 | $610 21.5% of $2,842 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 41 | $887 17.5% of $5,078 |
Schedule C
Plan-paid amounts to each named party on the filing, with the role they reported. This is not a carrier commission and is not added to Schedule A.
Visible subtotal $47,775
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group, LLC | Broker | $28,275 | $504.91 |
| Bsi Corporate Benefits | Broker | $24,215 | $432.41 |
| Hy Holdings Inc | Admin | $3,998 | $71.39 |
| Innovu | Other | $1,704 | $30.43 |
| Capital Bluecross | Admin | $-10,417 | $-186.02 |