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Employer
603 Industrial Drive, Orwigsburg, PA 17961 · EIN 26-1514340 · 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 $103,965
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Dental | United Concordia Insurance Company | Willis Towers Watson | 140 | $868 10.5% of $8,272 |
| Vision | Vision Benefits Of America | Tompkins Insurance | 124 | $80 3.6% of $2,243 |
| Life | Oneamerica Group | — | 573 | Schedule A not provided |
| Life | Oneamerica Group | — | 573 | Schedule A not provided |
| Accidental Death And Dismemberment | Oneamerica Group | — | 573 | Schedule A not provided |
| Accidental Death And Dismemberment | Oneamerica Group | — | 573 | Schedule A not provided |
| Other | Oneamerica Group | — | 573 | Schedule A not provided |
| Other | Oneamerica Group | — | 573 | Schedule A not provided |
| Dental | United Concordia Insurance Company | Willis Towers Watson | 291 | $8,320 9.3% of $89,695 |
| Dental | United Concordia Insurance Company | Usi Insurance Services (Ri) | 291 | $921 1.0% of $89,695 |
| Vision | Vision Benefits Of America | — | 187 | Schedule A not provided |
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.
No Schedule C parties in this year.