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Employer
Po Box 105, Fleetwood, PA 19522 · EIN 23-0586213 · Oct 1, 2024 to Sep 30, 2025
Plan year 2024
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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 $7,807
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optumhealth | — | 38 | Comp not disclosed Premium $256,309 |
| Dental | Sunlife Assurance Company Of Canada | Patriot (Power-Kunkle Group, Inc.) | 43 | $2,151 11.2% of $19,143 |
| Dental | Sunlife Assurance Company Of Canada | James R Nelligan & Associates | 43 | $1,345 7.0% of $19,143 |
| Vision | Vba | Patriot (Power-Kunkle Group, Inc.) | 45 | $274 5.0% of $5,469 |
| Vision | Vba | James R Nelligan & Associates | 45 | $274 5.0% of $5,469 |
| Life | United Of Omaha Life Insurance Company | Patriot (Power-Kunkle Group, Inc.) | 46 | $696 16.1% of $4,335 |
| Life | United Of Omaha Life Insurance Company | James R Nelligan & Associates | 46 | $217 5.0% of $4,335 |
| Life | United Of Omaha Life Insurance Company | Gi George Parent Lp | 46 | $95 2.2% of $4,335 |
| Other | United Of Omaha Life Insurance Company | Patriot (Power-Kunkle Group, Inc.) | 46 | $1,073 16.0% of $6,723 |
| Other | United Of Omaha Life Insurance Company | James R Nelligan & Associates | 46 | $336 5.0% of $6,723 |
| Other | United Of Omaha Life Insurance Company | Gi George Parent Lp | 46 | $146 2.2% of $6,723 |
| Term Life Voluntary | United Of Omaha Life Insurance Company | Patriot (Power-Kunkle Group, Inc.) | 26 | $823 14.4% of $5,708 |
| Term Life Voluntary | United Of Omaha Life Insurance Company | James R Nelligan & Associates | 26 | $285 5.0% of $5,708 |
| Term Life Voluntary | United Of Omaha Life Insurance Company | Gi George Parent Lp | 26 | $92 1.6% of $5,708 |
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 $51,969
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Power Kunkle Group | Broker | $18,864 | $377.28 |
| L. R. Weber | Broker | $15,181 | $303.62 |
| The Benecon Group | Broker | $10,707 | $214.14 |
| Pbasc | Broker | $3,648 | $72.96 |
| Young, Oakes, Brown & Co | Broker | $425 | $8.50 |
| Capital Blue Cross | Admin | $3,144 | $62.88 |