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Employer
240 Main Street, Topton, PA 19562 · EIN 38-2002072 · Jan 1, 2024 to Dec 31, 2024
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 $11,408
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 81 | Comp not disclosed Premium $570,563 |
| Dental | United Concordia Insurance Company | Patriot (Power-Kunkle Group, Inc.) | 144 | $4,416 9.9% of $44,463 |
| Vision | Highmark Inc. | Patriot (Power-Kunkle Group, Inc.) | 131 | $274 4.9% of $5,547 |
| Vision | Highmark Inc. | Willis Towers Watson Northeast, Inc | 131 | $89 1.6% of $5,547 |
| Life | United Of Omaha Life Insurance Company | Patriot Growth Insurance Svcs LLC | 100 | $911 10.0% of $9,107 |
| Life | United Of Omaha Life Insurance Company | Patriot (Power-Kunkle Group, Inc.) | 100 | $287 3.2% of $9,107 |
| Life | United Of Omaha Life Insurance Company | Gi George Parent Lp | 100 | $148 1.6% of $9,107 |
| Life | United Of Omaha Life Insurance Company | James R. Nelligan & Associats | 100 | $148 1.6% of $9,107 |
| Other | United Of Omaha Life Insurance Company | Patriot Growth Insurance Svcs LLC | 7 | $183 10.0% of $1,832 |
| Other | United Of Omaha Life Insurance Company | Patriot (Power-Kunkle Group, Inc.) | 7 | $81 4.4% of $1,832 |
| Other | United Of Omaha Life Insurance Company | Gi George Parent Lp | 7 | $43 2.3% of $1,832 |
| Other | United Of Omaha Life Insurance Company | James R Nelligan & Associates | 7 | $29 1.6% of $1,832 |
| Other | United Of Omaha Life Insurance Company | Patriot Growth Insurance Svcs LLC | 100 | $2,965 10.0% of $29,649 |
| Other | United Of Omaha Life Insurance Company | Patriot (Power-Kunkle Group, Inc.) | 100 | $896 3.0% of $29,649 |
| Other | United Of Omaha Life Insurance Company | James R Nelligan & Associates | 100 | $482 1.6% of $29,649 |
| Other | United Of Omaha Life Insurance Company | Gi George Parent Lp | 100 | $456 1.5% of $29,649 |
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 $41,693
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Patriot (Power-Kunkle Group, Inc.) | Broker | $34,020 | $236.25 |
| The Benecon Group | Broker | $19,695 | $136.77 |
| ConnectCare3 | Patient Advocate | $5,564 | $38.64 |
| Highmark Blue Shield (Central) | Admin | $-17,586 | $-122.13 |