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Employer
711 Spring Street, Wyomissing, PA 19610 · EIN 81-3983474 · 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 $14,350
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | 59 | Comp not disclosed Premium $313,705 |
| Dental | United Concordia Insurance Company | Tompkins Insurance | 64 | $1,994 8.0% of $24,989 |
| Dental | United Concordia Insurance Company | Emerson Rogers LLC | 64 | $942 3.8% of $24,989 |
| Vision | Highmark Inc | Brunner, Stephen D | 65 | $256 5.7% of $4,493 |
| Vision | Highmark Inc | Seidel, Kelsey Shalayne | 65 | $30 0.7% of $4,493 |
| Vision | Highmark Inc | Emerson Rogers LLC | 65 | $15 0.3% of $4,493 |
| Life | United Of Omaha Life Insurance Company | Tompkins Insurance | 73 | $682 7.2% of $9,482 |
| Life | United Of Omaha Life Insurance Company | Emerson Rogers LLC | 73 | $399 4.2% of $9,482 |
| Life | United Of Omaha Life Insurance Company | James R Nelligan & Associates | 73 | $341 3.6% of $9,482 |
| Life | United Of Omaha Life Insurance Company | Tompkins Insurance | 34 | $1,313 7.7% of $17,139 |
| Life | United Of Omaha Life Insurance Company | James R Nelligan & Associates | 34 | $656 3.8% of $17,139 |
| Life | United Of Omaha Life Insurance Company | Emerson Rogers LLC | 34 | $602 3.5% of $17,139 |
| Other | United Of Omaha Life Insurance Company | Tompkins Insurance | 73 | $1,359 7.2% of $18,815 |
| Other | United Of Omaha Life Insurance Company | Emerson Rogers LLC | 73 | $784 4.2% of $18,815 |
| Other | United Of Omaha Life Insurance Company | James R Nelligan & Associates | 73 | $679 3.6% of $18,815 |
| Voluntary Long-Term Disability | United Of Omaha Life Insurance Company | Tompkins Agencies Inc | 33 | $2,125 7.4% of $28,654 |
| Voluntary Long-Term Disability | United Of Omaha Life Insurance Company | Emerson Rogers LLC | 33 | $1,111 3.9% of $28,654 |
| Voluntary Long-Term Disability | United Of Omaha Life Insurance Company | James R Nelligan & Associates | 33 | $1,062 3.7% of $28,654 |
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 $58,827
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Tompkins Insurance | Broker | $19,110 | $261.78 |
| The Benecon Group | Broker | $16,571 | $227.00 |
| Capital Bluecross | Carrier | $9,082 | $124.41 |
| ConnectCare3 | Patient Advocate | $3,516 | $48.16 |
| ConnectCare3 | Patient Advocate | $3,516 | $48.16 |
| ConnectCare3 | Patient Advocate | $3,516 | $48.16 |
| ConnectCare3 | Patient Advocate | $3,516 | $48.16 |