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Employer
30 E D Preate Drive, Moosic, PA 18507 · EIN 24-0603570 · 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 $59,828
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Crum & Forster | — | 394 | Comp not disclosed Premium $320,733 |
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | 402 | Comp not disclosed Premium $908,666 |
| Dental | United Concordia Companies, Inc. | — | — | Schedule A not provided |
| Vision | Highmark Inc. | — | 866 | Comp not disclosed Premium $44,372 |
| Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 548 | $10,304 12.9% of $79,610 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 543 | $8,359 13.0% of $64,495 |
| Crit Ill Vol | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 68 | $823 10.0% of $8,230 |
| Accident Vol | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 100 | $1,096 10.0% of $10,959 |
| Other | United Of Omaha Life Insurance Company | United Of Omaha Life Insurance Comp | 552 | $15,496 100.0% of $15,496 |
| Hosp Indem Vol | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 51 | $1,054 10.0% of $10,538 |
| Term Life Vol | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 235 | $22,457 18.4% of $122,144 |
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 $675,573
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Bsi Corporate Benefits, Inc. | Broker | $132,972 | $329.96 |
| Lr Webber | Broker | $94,953 | $235.62 |
| The Benecon Group, LLC | Broker | $55,205 | $136.99 |
| Highmark Bcbs Nepa | Admin | $319,223 | $792.12 |
| Prime Therapeutics | Admin | $48,024 | $119.17 |
| Pbasc | Admin | $13,831 | $34.32 |
| Young, Oakes, Brown & Co | Accountant | $11,365 | $28.20 |