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Employer
1185 Win Drive, Bethlehem, PA 18017 · EIN 22-2330200 · Oct 1, 2024 to Sep 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 $41,685
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Berkley Life And Health Insurance Co. | — | — | Schedule A not provided |
| Stop-loss | Companion Life Insurance Company | — | — | Schedule A not provided |
| Dental | Guardian | Brown & Brown Insurance Services In | 119 | $184 2.4% of $7,779 |
| Vision | Capital Advantage Assurance Company | — | 213 | Comp not disclosed Premium $13,190 |
| Life | United Of Omaha Life Insurance Company | Brown & Brown Insurance Svcs Inc | 128 | $4,065 15.6% of $26,036 |
| Life | United Of Omaha Life Insurance Company | Brown & Brown Of Lehigh Valley Lp | 128 | $655 2.5% of $26,036 |
| AD&D | United Of Omaha Life Insurance Company | Brown & Brown Insurance Svcs Inc | 25 | $2,332 15.5% of $15,035 |
| AD&D | United Of Omaha Life Insurance Company | Brown & Brown Of Lehigh Valley Lp | 25 | $347 2.3% of $15,035 |
| Other | United Of Omaha Life Insurance Company | Brown & Brown Insurance Svcs Inc | 126 | $7,111 15.6% of $45,486 |
| Other | United Of Omaha Life Insurance Company | Brown & Brown Of Lehigh Valley Lp | 126 | $1,104 2.4% of $45,486 |
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.
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Capital Advantage Assurance Company | Admin | Comp not disclosed | — |