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Employer
2630 Westview Drive, Wyomissing, PA 19610 · EIN 23-2628951 · 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 $7,417
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | 13 | Comp not disclosed Premium $66,679 |
| Dental | United Concordia Insurance Company | Erc Of Ny, Inc | — | $398 6.7% of $5,966 |
| Life | Standard Insurance Company | — | 3 | Schedule A not provided |
| Life | Standard Insurance Company | — | 3 | Schedule A not provided |
| Life | Standard Insurance Company | Tompkins Insurance | 20 | $219 14.4% of $1,521 |
| Life | Standard Insurance Company | James R Nelligan & Associates | 20 | $121 8.0% of $1,521 |
| AD&D | Standard Insurance Company | Tompkins Insurance | 20 | $36 14.2% of $253 |
| AD&D | Standard Insurance Company | James R Nelligan & Associates | 20 | $20 7.9% of $253 |
| Other | Standard Insurance Company | Tompkins Insurance | 3 | $1,316 17.8% of $7,375 |
| Other | Standard Insurance Company | James R Nelligan & Associates | 3 | $585 7.9% of $7,375 |
| Other | Standard Insurance Compnay | Tompkins Insurance | 3 | $824 15.3% of $5,376 |
| Other | Standard Insurance Compnay | James R Nelligan & Associates | 3 | $425 7.9% of $5,376 |
| Other | Standard Insurance Company | Tompkins Insurance | 20 | $1,282 17.9% of $7,145 |
| Other | Standard Insurance Company | James R Nelligan & Associates | 20 | $573 8.0% of $7,145 |
| Other | Standard Insurance Company | Tompkins Insurance | 20 | $802 15.4% of $5,198 |
| Other | Standard Insurance Company | James R Nelligan & Associates | 20 | $416 8.0% of $5,198 |
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 $9,501
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group | Broker | $5,649 | $282.45 |
| Tompkins Insurance | Broker | $3,200 | $160.00 |
| ConnectCare3 | Patient Advocate | $694 | $34.70 |
| Capital Bluecross | Admin | $-42 | $-2.10 |