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Employer
1902 Vultee Street, Allentown, PA 18103 · EIN 23-1439879 · 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 $7,695
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | 48 | Comp not disclosed Premium $195,299 |
| Dental | Delta Dental Of Pennsylvania | Bsi Corporate Benefits, Inc. | 97 | $1,108 10.0% of $11,077 |
| Vision | Capital Advantage Assurance Company | — | — | Schedule A not provided |
| Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 70 | $1,127 30.6% of $3,685 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 19 | $1,781 31.6% of $5,633 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 23 | $2,583 30.5% of $8,461 |
| Vol Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 16 | $1,096 31.8% of $3,444 |
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 $53,975
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Bsi Corporate Benefits, LLC | Broker | $36,787 | $379.25 |
| The Benecon Group, LLC | Broker | $16,743 | $172.61 |
| Hy Holdings Inc | Admin | $9,256 | $95.42 |
| ConnectCare3 | Other | $3,627 | $37.39 |
| Innovu | Other | $2,792 | $28.78 |
| Capital Bluecross | Admin | $-15,230 | $-157.01 |