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Employer
625 Spring Street, Suite 200, Reading, PA 19610 · EIN 23-2612776 · 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 $16,461
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Capital Advantage Assurance Company | Acrisure, LLC DBA Ashton Benefits | 67 | $9,480 1.4% of $682,477 |
| Medical | Capital Advantage Assurance Company | Kistler Tiffany Benefits Co | 67 | $1,120 0.2% of $682,477 |
| Dental | United Concordia Insurance Company | — | 72 | Schedule A not provided |
| Dental | United Concordia Insurance Company | — | 72 | Schedule A not provided |
| Dental | United Concordia Insurance Company | — | 72 | Schedule A not provided |
| Vision | Vision Benefits Of America | Acrisure, LLC DBA Ashton Benefits | 36 | $317 7.0% of $4,541 |
| Vision | Vision Benefits Of America | Kistler Tiffany Benefits Co | 36 | $54 1.2% of $4,541 |
| Life | American United Life | R & B Insurance Services, LLC | 12 | $2,304 15.7% of $14,629 |
| Life | American United Life | Kistler Tiffany Benefits Co | 12 | $319 2.2% of $14,629 |
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 $1,458
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Acrisure, LLC | Broker | $1,348 | $18.72 |
| The Benecon Group | Broker | $110 | $1.53 |