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Employer
2289 Avenue A, Bethlehem, PA 18017 · EIN 23-1679102 · Dec 1, 2024 to Nov 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 $9,283
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Crum & Forster | — | 81 | Comp not disclosed Premium $316,068 |
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | 85 | Comp not disclosed Premium $31,982 |
| Dental | Delta Dental Of Pennsylvania | — | 65 | Schedule A not provided |
| Vision | Capital Advantage Assurance Company | Bsi Corporate Benefits, Inc. | 108 | $238 4.0% of $5,948 |
| Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 53 | $841 18.2% of $4,610 |
| AD&D | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 27 | $1,989 23.3% of $8,539 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 53 | $3,179 18.3% of $17,362 |
| Voluntary Critical Illness | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 4 | $164 15.0% of $1,093 |
| Accident Only Voluntary | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 8 | $401 20.5% of $1,957 |
| Hospital Indemnity - Voluntary | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 1 | $183 34.7% of $528 |
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 $110,673
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group | Broker | $66,052 | $611.59 |
| Bsi Corporate Benefits, LLC | Broker | $60,664 | $561.70 |
| Innovu | Other | $4,229 | $39.16 |
| Capital Blue Cross | Admin | $-20,272 | $-187.70 |