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Employer
1380 Mt. Cobb Road, Jefferson Township, PA 18436 · EIN 81-2906480 · Jan 1, 2023 to Dec 31, 2023
Plan year 2023
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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 $54,475
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Highmark, Inc. | Onesource Benefit Solutions | 96 | $12,528 1.3% of $943,638 |
| Medical | Highmark, Inc. | David Keller | 96 | $12,276 1.3% of $943,638 |
| Medical | Highmark, Inc. | — | 4 | Comp not disclosed Premium $40,714 |
| Dental | Delta Dental Of Pennsylvania | Onesource Benefit Solutions | 129 | $3,382 10.0% of $33,822 |
| Dental | Delta Dental Of Pennsylvania | Emerson Rogers LLC | 129 | $1,353 4.0% of $33,822 |
| Vision | Highmark, Inc. | Onesource Benefit Solutions | 143 | $154 1.5% of $10,079 |
| Vision | Highmark, Inc. | David Keller | 143 | $140 1.4% of $10,079 |
| Life | United Of Omaha Life Insurance Company | Emerson Rogers LLC | 125 | $1,378 19.6% of $7,025 |
| Life | United Of Omaha Life Insurance Company | Emerson Rogers LLC | 54 | $6,666 23.6% of $28,271 |
| Other | United Of Omaha Life Insurance Company | Emerson Rogers LLC | 45 | $8,326 24.4% of $34,129 |
| Critical Illness | United Of Omaha Life Insurance Company | Emerson Rogers LLC | 33 | $959 18.5% of $5,186 |
| Accident | United Of Omaha Life Insurance Company | Emerson Rogers LLC | 37 | $1,517 18.7% of $8,094 |
| Other | United Of Omaha Life Insurance Company | Emerson Rogers LLC | 40 | $5,796 22.3% of $25,988 |
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.