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Employer
2260 Avenue A, Bethlehem, PA 18017 · EIN 23-1599610 · Jan 1, 2024 to Dec 31, 2024
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 $64,680
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Avalon Insurance Company | — | 425 | Comp not disclosed Premium $781,506 |
| Dental | Capital Advantage Assurance Company | Bsi Corporate Benefits, Inc. | 438 | $8,283 5.0% of $165,667 |
| Life | Hartford Life And Accident | Bsi Corporate Benefits, Inc. | 250 | $12,523 12.5% of $100,186 |
| Life | Hartford Life And Accident | Emerson Rogers LLC | 250 | $10,645 10.6% of $100,186 |
| Life | Hartford Life And Accident | Bsi Corporate Benefits, Inc. | 341 | $23,192 18.3% of $126,579 |
| Life | Hartford Life And Accident | Emerson Rogers LLC | 341 | $3,828 3.0% of $126,579 |
| Life | Metropolitan Life Insurance Company | Bsi Corporate Benefits, Inc. | — | $6,209 7.8% of $79,604 |
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 $-522,446
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Bsi Corporate Benefits, LLC | Broker | $150,450 | $343.49 |
| The Benecon Group | Broker | $66,096 | $150.90 |
| Hy Holdings Inc | Admin | $44,178 | $100.86 |
| ConnectCare3 | Other | $22,950 | $52.40 |
| Innovu | Other | $20,400 | $46.58 |
| Capital Advantage Assurance Company | Admin | $-826,520 | $-1,887.03 |