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Employer
7172 Route 522 North, Middleburg, PA 17842 · EIN 47-1409422 · 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.
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | 83 | Comp not disclosed Premium $378,500 |
| Dental | The Guardian Life Insurance Company Of America | — | — | Schedule A not provided |
| Life | Kansas City Life Insurance Company | — | — | Schedule A not provided |
| AD&D | Unum Life Insurance Company Of America | — | — | Schedule A not provided |
| AD&D | Unum Life Insurance Company Of America | — | — | Schedule A not provided |
| Other | Unum Life Insurance Company Of America | — | — | Schedule A not provided |
| Group Accident | Unum Life Insurance Company Of America | — | — | Schedule A not provided |
| Group Accident | Unum Life Insurance Company Of America | — | — | Schedule A not provided |
| Age Cci | Unum Life Insurance Company Of America | — | — | Schedule A not provided |
| Age Cci | Unum Life Insurance Company Of 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 $32,301
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group | Broker | $20,010 | $241.08 |
| Commonwealth Financial Group | Broker | $18,981 | $228.69 |
| Mpb Risk Services, LLC | Broker | $8,667 | $104.42 |
| Connectcare 3 | Patient Advocate | $5,653 | $68.11 |
| Capital Bluecross | Admin | $-21,010 | $-253.13 |