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Employer
110 East Main Street, Adamstown, PA 19501 · EIN 23-1922616 · 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 $18,810
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Avalon Insurance Company | — | 147 | Comp not disclosed Premium $476,275 |
| Dental | Delta Dental Of Pennsylvania | Brown & Brown Of Pennsylvania | 224 | $7,213 10.0% of $72,134 |
| Vision | Eyemed Vision Care | — | 164 | Comp not disclosed Premium $11,083 |
| Life | United Of Omaha Life Insurance Company | Brown & Brown Of Pennsylvania | 169 | $2,398 13.7% of $17,455 |
| Life | United Of Omaha Life Insurance Company | Brown & Brown Insurance Svcs Inc | 169 | $220 1.3% of $17,455 |
| AD&D | United Of Omaha Life Insurance Company | Brown & Brown Of Pennsylvania | 49 | $3,804 13.7% of $27,750 |
| AD&D | United Of Omaha Life Insurance Company | Brown & Brown Insurance Svcs Inc | 49 | $359 1.3% of $27,750 |
| Other | United Of Omaha Life Insurance Company | Brown & Brown Of Pennsylvania | 63 | $3,075 13.7% of $22,385 |
| Other | United Of Omaha Life Insurance Company | Brown & Brown Insurance Svcs Inc | 63 | $282 1.3% of $22,385 |
| Voluntary Long Term Disability | United Of Omaha Life Insurance Company | Brown & Brown Of Pennsylvania | 28 | $1,334 13.7% of $9,724 |
| Voluntary Long Term Disability | United Of Omaha Life Insurance Company | Brown & Brown Insurance Svcs Inc | 28 | $125 1.3% of $9,724 |
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 $180,946
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Brown & Brown (Pa) | Broker | $94,930 | $423.79 |
| The Benecon Group | Broker | $35,927 | $160.39 |
| Highmark Blue Shield (Central) | Admin | $40,665 | $181.54 |
| ConnectCare3 | Patient Advocate | $9,424 | $42.07 |