Employer
Country Cupboard Inn
115 Farley Circle, Lewisburg, PA 17837 · EIN 23-1886253 · Jan 1, 2025 to Dec 31, 2025
Plan year 2025
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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 $890
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Crum & Forster | — | 31 | Comp not disclosed Premium $109,467 |
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | — | Comp not disclosed Premium $890 |
| Dental | Delta Dental Of Pennsylvania | — | 35 | Schedule A not provided |
| Vision | Vision Benefits Of America | Brown & Brown Of Pennsylvania | 27 | $121 5.0% of $2,420 |
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 $41,628
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group, LLC | Broker | $26,836 | $766.74 |
| Brown & Brown (Pa) | Broker | $11,220 | $320.57 |
| Geisinger Health Plan | Admin | $2,092 | $59.77 |
| Innovu | Other | $1,480 | $42.29 |