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Employer
1961 Fulling Mill Road, Middletown, PA 17057 · EIN 43-1308784 · 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 $9,963
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | — | Comp not disclosed Premium $822 |
| Stop-loss | Crum & Forster | — | 29 | Comp not disclosed Premium $206,736 |
| Dental | Starmount Life Insurance Company | Colonial Park Realty | 28 | $2,499 11.9% of $20,996 |
| Dental | Starmount Life Insurance Company | Bh Preferred | 28 | $822 3.9% of $20,996 |
| Dental | Starmount Life Insurance Company | Centro Benefits Research | 28 | $341 1.6% of $20,996 |
| Vision | Capital Advantage Assurance Company | Colonial Park Realty DBA Ender | 51 | $121 4.0% of $3,026 |
| Life | Unum Life Insurance Company Of America | Colonial Park Realty | 32 | $4,050 13.1% of $30,870 |
| Life | Unum Life Insurance Company Of America | Bh Preferred | 32 | $1,411 4.6% of $30,870 |
| Life | Unum Life Insurance Company Of America | Centro Benefits Research | 32 | $111 0.4% of $30,870 |
| AD&D | Unum Life Insurance Company Of America | Colonial Park Realty | 9 | $462 15.8% of $2,932 |
| AD&D | Unum Life Insurance Company Of America | Bh Preferred | 9 | $129 4.4% of $2,932 |
| AD&D | Unum Life Insurance Company Of America | Centro Benefits Research | 9 | $17 0.6% of $2,932 |
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 $56,585
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group, LLC | Broker | $38,436 | $753.65 |
| Enders Insurance Associates | Broker | $10,560 | $207.06 |
| Revivehealth, Inc. | Other | $4,563 | $89.47 |
| Capital Bluecross | Admin | $3,026 | $59.33 |