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Employer
301 South Warren Street, Orwigsburg, PA 17961 · EIN 23-1923508 · May 1, 2024 to Apr 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 $2,561
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | 306 | Comp not disclosed Premium $989,649 |
| Stop-loss | Crum & Forster | — | 327 | Comp not disclosed Premium $536,870 |
| Dental | The Lincoln National Life Insurance Company | Hays Companies, Inc. | 295 | $861 1.3% of $65,205 |
| Vision | Vision Benefits Of America | Hays Companies,Inc. | 324 | $1,700 5.0% of $34,008 |
| Life | The Lincoln National Life Insurance Company | — | 437 | Comp not disclosed Premium $4,174 |
| Other | The Lincoln National Life Insurance Company | — | 230 | Comp not disclosed Premium $24,663 |
| Voluntary Term Life, Voluntary Child Life, Voluntary Spouse Life | The Lincoln National Life Insurance Company | — | 154 | Comp not disclosed Premium $16,748 |
| Other | Lincoln National Life Insurance Company | — | 438 | Comp not disclosed Premium $63,148 |
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 $430,584
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group | Broker | $145,934 | $333.18 |
| Brown & Brown Of Pa | Broker | $59,926 | $136.82 |
| Capital Advantage Assurance Co | Admin | $209,572 | $478.47 |
| Innovu | Other | $15,152 | $34.59 |