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Employer
3056 East State Street, Hermitage, PA 16148 · EIN 25-0969420 · 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 $8,429
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 59 | Comp not disclosed Premium $430,261 |
| AD&D | United Of Omaha Life Insurance Company | The Dbj Group Inc | 27 | $1,478 13.2% of $11,228 |
| AD&D | United Of Omaha Life Insurance Company | Dmc Benefits Inc | 27 | $786 7.0% of $11,228 |
| AD&D | United Of Omaha Life Insurance Company | Highstreet Insurance Services North | 27 | $513 4.6% of $11,228 |
| Voluntary Dental | United Of Omaha Life Insurance Company | The Dbj Group Inc | 49 | $1,274 6.6% of $19,275 |
| Voluntary Dental | United Of Omaha Life Insurance Company | Dmc Benefits Inc | 49 | $964 5.0% of $19,275 |
| Voluntary Dental | United Of Omaha Life Insurance Company | Highstreet Insurance Services North | 49 | $301 1.6% of $19,275 |
| Voluntary Critical Illness | United Of Omaha Life Insurance Company | The Dbj Group Inc | 19 | $819 14.1% of $5,800 |
| Voluntary Critical Illness | United Of Omaha Life Insurance Company | Dmc Benefits Inc | 19 | $406 7.0% of $5,800 |
| Voluntary Critical Illness | United Of Omaha Life Insurance Company | Highstreet Insurance Services North | 19 | $185 3.2% of $5,800 |
| Voluntary Accident | United Of Omaha Life Insurance Company | The Dbj Group Inc | 19 | $704 13.1% of $5,375 |
| Voluntary Accident | United Of Omaha Life Insurance Company | Dmc Benefits Inc | 19 | $376 7.0% of $5,375 |
| Voluntary Accident | United Of Omaha Life Insurance Company | Highstreet Insurance Services North | 19 | $244 4.5% of $5,375 |
| Voluntary Vision | United Of Omaha Life Insurance Company | The Dbj Group Inc | 28 | $260 6.9% of $3,787 |
| Voluntary Vision | United Of Omaha Life Insurance Company | Highstreet Insurance Services North | 28 | $119 3.1% of $3,787 |
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 $98,511
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group LLC | Broker | $78,370 | $1,328.31 |
| Highstreet Insurance Services North | Broker | $20,760 | $351.86 |
| Highmark West | Admin | $-619 | $-10.49 |