Loading employer…
Employer
336 W. Spruce Street, Bethlehem, PA 18018 · EIN 23-1457999 · Jul 1, 2024 to Jun 30, 2025
Plan year 2024
View
Schedule A
Coverage contracts on the filing. If the carrier did not provide Schedule A, the row is listed with that note.
Visible subtotal $14,401
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Dental + Vision | Capital Advantage Assurance Company | Bsi Corporate Benefits, Inc. | 115 | $4,322 9.2% of $46,868 |
| Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 104 | $1,448 18.2% of $7,977 |
| AD&D | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 40 | $1,868 23.2% of $8,049 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 104 | $1,902 18.2% of $10,427 |
| Vol Acc | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 21 | $655 17.7% of $3,707 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 104 | $4,206 18.2% of $23,148 |
| Stop-loss | HM Life Insurance Company | — | 89 | Comp not disclosed Premium $200,981 |
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 $117,346
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Bsi Corporate Benefits, LLC | Broker | $56,018 | $571.61 |
| The Benecon Group | Broker | $26,739 | $272.85 |
| Hy Holdings Inc. | Broker | $9,861 | $100.62 |
| Capital Blue Cross | Admin | $20,193 | $206.05 |
| Innovu | Other | $4,535 | $46.28 |