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Employer
1300 Dunham Drive, Dunmore, PA 18512 · EIN 23-2281067 · Apr 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 $13,959
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 124 | Comp not disclosed Premium $513,877 |
| Dental | The Guardian Life Insurance Company Of America | Universal Employee Benefits | 129 | $3,131 5.0% of $62,834 |
| Vision | Vision Benefits Of America | Universal Employee Benefits Solutio | 107 | $770 5.0% of $15,394 |
| Life | United Of Omaha Life Insurance Company | Creative Benefits, Inc | 141 | $2,027 12.9% of $15,740 |
| Voluntary Std | United Of Omaha Life Insurance Company | Creative Benefits, Inc | 2 | $1,856 37.0% of $5,012 |
| Other | United Of Omaha Life Insurance Company | Creative Benefits, Inc | 77 | $776 13.0% of $5,977 |
| Voluntary Life | United Of Omaha Life Insurance Company | Creative Benefits, Inc | 73 | $5,399 17.7% of $30,507 |
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 $138,375
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group | Broker | $104,597 | $843.52 |
| Highmark Bcbs Nepa | Admin | $19,829 | $159.91 |
| Revivehealth, Inc. | Admin | $13,949 | $112.49 |