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Employer
13555 Broadway Dr, Meadville, PA 16335 · EIN 25-1576100 · Jul 1, 2024 to Jun 30, 2025
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 $1,606
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 454 | Comp not disclosed Premium $928,507 |
| Vision | Vision Benefits Of America | The Dbj Group Inc | 467 | $1,606 3.5% of $45,521 |
| Life | Life Insurance Company Of North America | — | — | Schedule A not provided |
| AD&D | Life Insurance Company Of North America | — | — | Schedule A not provided |
| Other | Life Insurance Company Of North America | — | — | Schedule A not provided |
| Other | Life Insurance Company Of North America | — | — | Schedule A not provided |
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 $299,472
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group, LLC | Broker | $73,401 | $161.68 |
| Highstreet Insurance Services North | Broker | $-10,948 | $-24.11 |
| Highmark West | Admin | $111,026 | $244.55 |
| Highmark Blue Shield (Central) | Admin | $34,998 | $77.09 |
| ConnectCare3 | Patient Advocate | $25,512 | $56.19 |
| The Djb Group | Broker | $18,417 | $39.44 |
| United Concordia Companies, Inc. | Admin | $47,066 | $100.78 |