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Employer
Po Box 175, Lake Winola, PA 18625 · EIN 23-2221496 · Jul 1, 2024 to Jun 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 $17,401
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Dental | Delta Dental Of Pennsylvania | C3 Group, LLC | 75 | $166 0.5% of $36,725 |
| Dental | Delta Dental Of Pennsylvania | Emerson Rogers LLC | 75 | $67 0.2% of $36,725 |
| Dental | Delta Dental Of Pennsylvania | James R Nelligan & Associates | 75 | $668 1.8% of $36,725 |
| Dental | Delta Dental Of Pennsylvania | The Equinox Agency LLC | 75 | $1,836 5.0% of $36,725 |
| Vision | Vision Servcie Plan | Employee Navigator LLC | 74 | $21 0.2% of $8,571 |
| Vision | Vision Servcie Plan | James R Nelligan & Associates | 74 | $495 5.8% of $8,571 |
| Vision | Vision Servcie Plan | The Equinox Agency LLC | 74 | $681 7.9% of $8,571 |
| AD&D | United Of Omaha Life Insurance Company | James R Nelligan & Associates | 105 | $1,000 24.7% of $4,047 |
| AD&D | United Of Omaha Life Insurance Company | James R Nelligan & Associates | 54 | $4,262 25.4% of $16,769 |
| Other | United Of Omaha Life Insurance Company | James R Nelligan & Associates | 67 | $5,185 24.7% of $21,021 |
| Other | United Of Omaha Life Insurance Company | James R Nelligan & Associates | 53 | $3,020 24.8% of $12,175 |
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.
No Schedule C parties in this year.