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Employer
1802 Paper Mill Road, Wyomissing, PA 19610 · EIN 23-1720360 · 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 $11,034
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 31 | Comp not disclosed Premium $22,902 |
| Life | United Of Omaha Life Insurance Company | — | — | Schedule A not provided |
| Stop-loss | HM Life Insurance Company | — | 38 | Comp not disclosed Premium $208,646 |
| Life | United Of Omaha Life Insurance Company | Patriot (Power-Kunkle Group, Inc.) | 54 | $1,152 19.9% of $5,798 |
| Life | United Of Omaha Life Insurance Company | James R Nelligan & Associates | 54 | $290 5.0% of $5,798 |
| Life | United Of Omaha Life Insurance Company | Gi George Parent Lp | 54 | $114 2.0% of $5,798 |
| Other | United Of Omaha Life Insurance Company | — | 54 | Schedule A not provided |
| Other | United Of Omaha Life Insurance Company | — | 54 | Schedule A not provided |
| Other | United Of Omaha Life Insurance Company | — | 54 | Schedule A not provided |
| Other | United Of Omaha Life Insurance Company | Patriot (Power-Kunkle Group, Inc.) | 54 | $2,921 19.9% of $14,657 |
| Other | United Of Omaha Life Insurance Company | James R Nelligan & Associates | 54 | $733 5.0% of $14,657 |
| Other | United Of Omaha Life Insurance Company | Gi George Parent Lp | 54 | $292 2.0% of $14,657 |
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 $33,996
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Patriot (Power-Kunkle Group, Inc.) | Broker | $2,124 | $66.38 |
| The Benecon Group | Broker | $1,474 | $46.06 |
| Capital Bluecross | Admin | $354 | $11.06 |
| ConnectCare3 | Patient Advocate | $322 | $10.06 |
| Patriot (Power-Kunkle Group, Inc.) | Broker | $16,948 | $313.85 |
| The Benecon Group | Broker | $14,080 | $260.74 |
| Capital Bluecross | Admin | $-1,306 | $-24.19 |