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Employer
220 East First Street, Bethlehem, PA 18015 · EIN 11-4399353 · Jan 1, 2025 to Dec 31, 2025
Plan year 2025
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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 $194,623
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Highmark Inc | Lewis, Craig Michael | 552 | $126,621 3.0% of $4,229,655 |
| Dental | Delta Dental Of Pennsylvania | Mercer (Us), Inc. | 582 | $10,610 4.0% of $265,335 |
| Vision | Vsp | Mercer (Us), Inc. | 269 | $1,121 2.8% of $40,748 |
| Life | Prudential Insurance Company Of America | Mercer (Us), Inc. | 352 | $52,826 16.0% of $329,158 |
| Life | Prudential Insurance Company Of America | Img | 352 | $78 0.0% of $329,158 |
| Hospital Ee Paid | Unum Insurance Company | Mercer (Us), Inc. | 25 | $758 14.9% of $5,076 |
| Accident | Unum Insurance Company | Mercer (Us), Inc. | 27 | $998 15.1% of $6,596 |
| Critical Illness | Unum Insurance Company | Mercer (Us), Inc. | 29 | $1,611 12.4% of $13,006 |
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 $13,724
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Prudential Insurance Company Of | Admin | $13,724 | $23.58 |