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Employer
3410 West 12th Street, Erie, PA 16505 · EIN 25-1640170 · 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 $48,768
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Highmark Inc. | John R. Burgert | 133 | $26,517 2.0% of $1,355,263 |
| Vision | Continental American Insurance Company | Lillis Mckibben Bongiovanni & Co (L | 112 | $6,072 9.8% of $61,668 |
| Vision | Continental American Insurance Company | Marilyn Lee Wyman | 112 | $1,760 2.9% of $61,668 |
| Vision | Continental American Insurance Company | Lisa M Beck | 112 | $1,053 1.7% of $61,668 |
| Vision | Continental American Insurance Company | Smith Benefits Consulting Group LLC | 112 | $382 0.6% of $61,668 |
| Vision | Continental American Insurance Company | Karges Benefits Consulting Group | 112 | $315 0.5% of $61,668 |
| Vision | Continental American Insurance Company | Stephanie V Boomgaarden | 112 | $104 0.2% of $61,668 |
| Vision | Continental American Insurance Company | Raina Marie Tokar | 112 | $87 0.1% of $61,668 |
| Vision | Continental American Insurance Company | Myka Leanna Davis | 112 | $52 0.1% of $61,668 |
| Vision | Continental American Insurance Company | Drayke Karges | 112 | $47 0.1% of $61,668 |
| Vision | Continental American Insurance Company | Lori Lee Clark | 112 | $43 0.1% of $61,668 |
| Vision | Continental American Insurance Company | Patrick J Preisel | 112 | $31 0.1% of $61,668 |
| Vision | Continental American Insurance Company | Amanda D Stein | 112 | $23 0.0% of $61,668 |
| Vision | Continental American Insurance Company | Travis Albert Ling | 112 | $20 0.0% of $61,668 |
| Vision | Continental American Insurance Company | Douglas Richard Kamper | 112 | $6 0.0% of $61,668 |
| Vision | Continental American Insurance Company | Peggy L Stormer | 112 | $3 0.0% of $61,668 |
| Life | Hartford Life And Accident | Lillis Mckibben Bongiovanni & Co (L | 121 | $7,151 8.3% of $85,880 |
| Life | Hartford Life And Accident | Professional Group Plans Inc. | 121 | $5,102 5.9% of $85,880 |
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.