Employer

Wind Creek Bethlehem

77 Wind Creek Boulevard, Bethlehem, PA 18015 · EIN 83-3709270 · Jan 1, 2025 to Dec 31, 2025

Plan year 2025

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Schedule A

Direct compensation

Coverage contracts on the filing. If the carrier did not provide Schedule A, the row is listed with that note.

Visible subtotal $203,579

Coverage	Carrier	Broker	Lives	Direct comp
Stop-loss	Lloyds	Acrisure, LLC DBA Ashton Benefits	1304	$66,365 10.0% of $663,656
Dental	Guardian	Acrisure, LLC DBA Ashton Benefits	1310	$5,774 13.8% of $41,884
Dental	Guardian	Lassiterware, LLC	1310	$1,488 3.6% of $41,884
Vision	Vison Service Plan	149 Acrisure LLC	1330	$10,150 9.2% of $110,524
Life	United Of Omaha Life Insurance Company	Acrisure, LLC DBA Ashton Benefits	330	$20,197 18.0% of $112,479
Life	United Of Omaha Life Insurance Company	Fmlasource Inc	1441	$24,492 13.4% of $183,102
Life	United Of Omaha Life Insurance Company	Acrisure, LLC DBA Ashton Benefits	1441	$14,114 7.7% of $183,102
AD&D	Mutual Of Omaha Insurance Company	Acrisure, LLC DBA Ashton Benefits	383	$1,008 7.9% of $12,770
Other	United Of Omaha Life Insurance Company	Acrisure, LLC DBA Ashton Benefits	276	$2,724 3.1% of $88,757
Hospital Indem-Voluntary	United Of Omaha Life Insurance Company	Acrisure, LLC DBA Ashton Benefits	51	$2,541 20.0% of $12,705
Critical Illness Voluntary	United Of Omaha Life Insurance Company	Acrisure, LLC DBA Ashton Benefits	282	$13,517 20.0% of $67,587
Accident	United Of Omaha Life Insurance Company	Acrisure, LLC DBA Ashton Benefits	429	$16,451 23.1% of $71,176
Other	United Of Omaha Life Insurance Company	Acrisure, LLC DBA Ashton Benefits	516	$24,758 13.0% of $189,947

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 $519,498

Party	Type	Amount	$ / Enrolled / Year
Blue Cross And Blue Shield Of Alaba	None	$519,498	$360.51
National Cooperativerx	None	Comp not disclosed	—

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