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Employer
1243 Old Bernville Rd., Leesport, PA 19533 · EIN 23-2592926 · Jan 1, 2025 to Dec 31, 2025
Plan year 2025
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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 $10,086
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | — | Comp not disclosed Premium $850 |
| Stop-loss | Crum & Forster | — | 64 | Comp not disclosed Premium $201,174 |
| Dental | United Concordia Insurance Company | Tompkins Insurance | 96 | $2,941 10.8% of $27,183 |
| Vision | Vision Benefits Of America | Tompkins Insurance | 67 | $438 8.0% of $5,493 |
| Life | Equitable Financial Life Insurance Company Of America | Tompkins Insurance | 77 | $5,019 14.9% of $33,753 |
| Life | Equitable Financial Life Insurance Company Of America | James R Nelligan & Associates | 77 | $1,688 5.0% of $33,753 |
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.
Visible subtotal $56,106
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group, LLC | Broker | $43,734 | $455.56 |
| Tompkins Insurance | Broker | $20,580 | $214.38 |
| Revivehealth, Inc. | Other | $8,957 | $93.30 |
| Capital Bluecross | Admin | $-17,165 | $-178.80 |