Employer
Woodstone Golf Club, Inc.
3777 Dogwood Road,, Danielsville, PA 18038 · EIN 23-2971010 · Jan 1, 2025 to Jun 30, 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 $48
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 25 | Comp not disclosed Premium $68,720 |
| Dental | United Concordia Insurance Company | — | — | Schedule A not provided |
| Vision | Capital Advantage Assurance Company | Bsi Corporate Benefits, Inc. | 45 | $48 4.0% of $1,204 |
| Telemedicine | Healthiest You | — | — | Schedule A not provided |
Schedule C
Additional compensation
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 $19,875
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group | Broker | $13,484 | $299.64 |
| Bsi Corporate Benefits, LLC | Broker | $9,081 | $201.80 |
| Innovu | Other | $646 | $14.36 |
| Capital Bluecross | Admin | $-3,336 | $-74.13 |