Employer
Countertek Inc.
1215 Ridge Ave., Ephrata, PA 17522 · EIN 27-1061198 · Jan 1, 2025 to Dec 31, 2025
Plan year 2025
Covered lives: 35
Schedule A
Direct compensation
Coverage contracts on the filing. If the carrier did not provide Schedule A, the row is listed with that note.
Visible subtotal $1,927
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | — | Comp not disclosed Premium $459 |
| Stop-loss | Crum & Forster | — | 34 | Comp not disclosed Premium $124,085 |
| Dental | United Concordia Insurance Company | Tompkins Insurance Agencies, Inc. | 17 | $719 10.0% of $7,162 |
| Vision | Vision Benefits Of America | Tompkins Insurance Agencies, Inc. | 11 | $20 5.0% of $404 |
| Vision | Vision Benefits Of America | Tompkins Insurance Agencies, Inc. | 11 | $48 5.0% of $954 |
| Other | Unum Life Insurance Company Of America | Tompkins Insurance Agencies, Inc. | 35 | $872 14.8% of $5,874 |
| Other | Unum Life Insurance Company Of America | James R Nelligan & Associates | 35 | $268 4.6% of $5,874 |
Schedule C
Additional compensation
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 $15,862
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Tompkins Insurance | Broker | $12,840 | $366.86 |
| The Benecon Group, LLC | Broker | $3,022 | $86.34 |