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Employer
132 Excelsior Drive, Blandon, PA 19510 · EIN 23-2235980 · 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 $35,358
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | — | Comp not disclosed Premium $364 |
| Stop-loss | Crum & Forster | — | 243 | Comp not disclosed Premium $674,862 |
| Vision | Vision Service Plan | Bsi Corporate Benefits, Inc. | 218 | $1,386 4.7% of $29,272 |
| Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 259 | $7,105 22.6% of $31,467 |
| EAP | Health Advocate | — | — | Schedule A not provided |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 259 | $17,222 22.8% of $75,541 |
| Voluntary Term Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 63 | $9,645 22.7% of $42,426 |
| Telemedicine | Healthiest You | — | — | Schedule A not provided |
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 $127,364
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group | Broker | $151,154 | $583.61 |
| Bsi Corporate Benefits, LLC | Broker | $141,448 | $546.13 |
| Innovu | Broker | $11,853 | $45.76 |
| United Concordia Companies, Inc. | Admin | $14,782 | $57.07 |
| Capital Advantage Assurance Company | Admin | $-191,873 | $-740.82 |