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Employer
9735 Commerce Circle, Kutztown, PA 19530 · EIN 87-0513572 · 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 $21,743
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 62 | $8,085 31.2% of $25,941 |
| Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 189 | $4,698 22.7% of $20,700 |
| Other | United Of Omaha Life Insurance Company | United Of Omaha Life Insurance Comp | 190 | $3,329 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 190 | $276 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 190 | $5,355 15.6% of $34,345 |
| Stop-loss | Avalon Insurance Company | — | 153 | Comp not disclosed Premium $374,609 |
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 $-10,748
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| United Concordia Companies, Inc. | Admin | $5,928 | $31.20 |
| Capital Advantage Assurance Company | Admin | $3,521 | $18.53 |
| Inspira | Admin | $1,800 | $9.47 |
| The Benecon Group | Broker | $92,967 | $534.29 |
| Bsi Corporate Benefits, LLC | Broker | $-1,728 | $-9.93 |
| Innovu | Admin. | $8,330 | $47.87 |
| Capital Bluecross | Admin. | $-121,566 | $-698.66 |