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Employer
1702 Peninsula Drive, Erie, PA 16505 · EIN 25-1186369 · 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 $3,055
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 45 | Comp not disclosed Premium $208,684 |
| Dental | Delta Dental Of Pennsylvania | Highstreet Insurance Services North | 82 | $1,102 5.3% of $20,818 |
| Dental | Delta Dental Of Pennsylvania | The Dbj Group Inc | 82 | $599 2.9% of $20,818 |
| Vision | Highmark, Inc. | The Dbj Group Inc | 83 | $72 2.2% of $3,285 |
| Vision | Highmark, Inc. | Highstreet Insurance Services North | 83 | $36 1.1% of $3,285 |
| Life | Hartford Life And Accident | The Dbj Group Inc | 52 | $1,185 10.0% of $11,851 |
| Life | Hartford Life And Accident | High Street Insurance Partners, Inc | 52 | $61 0.5% of $11,851 |
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 $23,105
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group | Broker | $42,389 | $510.71 |
| Highmark Blue Shield (Central) | Admin | $854 | $10.29 |
| Highmark West | Admin | $-20,138 | $-242.63 |