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Employer
3400 High Point Blvd, Bethlehem, PA 18017 · EIN 23-7178820 · 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 $11,864
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Life | Provident Life And Accident Insurance Company | Van Epps, James H | 53 | $990 6.3% of $15,834 |
| Life | Provident Life And Accident Insurance Company | Block, Charles D | 53 | $990 6.3% of $15,834 |
| Life | Provident Life And Accident Insurance Company | Mcgriff, A Marsh & Mclennan Agency | 53 | $881 5.6% of $15,834 |
| Life | Prudential Insurance Company Of America | Marsh & Mclennan Agcy LLC | 358 | $1,845 2.6% of $69,962 |
| Life | Prudential Insurance Company Of America | Mcgriff An Mma Company | 358 | $1,091 1.6% of $69,962 |
| Life | Prudential Insurance Company Of America | Img | 358 | $80 0.1% of $69,962 |
| AD&D | Unum Life Insurance Company Of America | Mcgriff, A Marsh & Mclennan Ag | 58 | $1,957 11.9% of $16,412 |
| AD&D | Unum Life Insurance Company Of America | Bsi Corporate Benefits, Inc. | 58 | $598 3.6% of $16,412 |
| EAP | Preferred Eap | — | — | Schedule A not provided |
| Other | Unum Life Insurance Company Of America | Mcgriff, A Marsh & Mclennan Ag | 44 | $2,665 12.1% of $22,032 |
| Other | Unum Life Insurance Company Of America | Bsi Corporate Benefits, Inc. | 44 | $767 3.5% of $22,032 |
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 $-172,862
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| United Concordia Companies, Inc. | Admin | $13,055 | $35.48 |
| Capital Advantage Assurance Company | Admin | $-185,917 | $-505.21 |