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Employer
533 S Main St, Lewistown, PA 17044 · EIN 23-2175833 · 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 $9,875
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 60 | Comp not disclosed Premium $239,874 |
| Medical | Dominion National | Kish Benefits Consulting | 40 | $2,160 9.9% of $21,802 |
| Medical | Dominion National | Emerson Reid & Company | 40 | $973 4.5% of $21,802 |
| Vision | Vision Benefits Of America | Kish Benefits Consulting | 66 | $350 5.0% of $6,994 |
| Life | American Heritage Life Insurance Company | Deprospo Jennifer | 4 | $31 3.7% of $844 |
| Life | American Heritage Life Insurance Company | Kish Bank | 4 | $30 3.6% of $844 |
| Life | American Heritage Life Insurance Company | Croyle Collette R | 4 | $6 0.7% of $844 |
| Life | American Heritage Life Insurance Company | Deprospo Ins Consulting LLC | 4 | $5 0.6% of $844 |
| Life | American Heritage Life Insurance Company | Kish Bank | 17 | $290 3.6% of $8,087 |
| Life | American Heritage Life Insurance Company | Deprospo Jennifer | 17 | $148 1.8% of $8,087 |
| Life | American Heritage Life Insurance Company | Croyle Christopher A | 17 | $43 0.5% of $8,087 |
| Life | American Heritage Life Insurance Company | Croyle Collette R | 17 | $30 0.4% of $8,087 |
| Life | American Heritage Life Insurance Company | Deprospo Ins Consulting LLC | 17 | $20 0.2% of $8,087 |
| Life | American Heritage Life Insurance Company | Greninger Jr Samuel Clair | 17 | $3 0.0% of $8,087 |
| Life | American Heritage Life Insurance Company | R&B Insurance Services LLC | 17 | $3 0.0% of $8,087 |
| Life | American Heritage Life Insurance Company | Reeder Insurance LLC | 17 | $1 0.0% of $8,087 |
| Accident | American Heritage Life Insurance Company | Deprospo Jennifer | 2 | $31 4.3% of $717 |
| Accident | American Heritage Life Insurance Company | Kish Bank | 2 | $28 3.9% of $717 |
| Accident | American Heritage Life Insurance Company | Croyle Collette R | 2 | $10 1.4% of $717 |
| Accident | American Heritage Life Insurance Company | Deprospo Ins Consulting LLC | 2 | $3 0.4% of $717 |
| Cancer | American Heritage Life Insurance Company | Kish Bank (1aa80) | 1 | $39 10.6% of $369 |
| Cancer | American Heritage Life Insurance Company | Croyle Christopher A (1ay20) | 1 | $9 2.4% of $369 |
| Cancer | American Heritage Life Insurance Company | Croyle Christopher A (1ay30) | 1 | $6 1.6% of $369 |
| Cancer | American Heritage Life Insurance Company | Kish Bank (8g250) | 1 | $2 0.5% of $369 |
| Voluntary Short Term Disability | Companion Life | Kish Bank | 13 | $1,068 15.0% of $7,120 |
| Voluntary Short Term Disability | Companion Life | Deprospo Insurance Consulting LLC | 13 | $534 7.5% of $7,120 |
| Voluntary Short Term Disability | Companion Life | Kish Bank | 18 | $1,435 15.2% of $9,469 |
| Voluntary Short Term Disability | Companion Life | Deprospo Insurance Consulting LLC | 18 | $718 7.6% of $9,469 |
| Voluntary Short Term Disability | Companion Life | Kish Bank | 8 | $358 15.0% of $2,385 |
| Voluntary Short Term Disability | Companion Life | Deprospo Insurance Consulting LLC | 8 | $179 7.5% of $2,385 |
| Other | American Heritage Life Insurance Company | Kish Bank | 1 | $66 6.4% of $1,027 |
| Other | American Heritage Life Insurance Company | Deprospo Jennifer | 1 | $34 3.3% of $1,027 |
| Other | American Heritage Life Insurance Company | Croyle Collette R | 1 | $8 0.8% of $1,027 |
| Other | American Heritage Life Insurance Company | Croyle Christopher A | 1 | $6 0.6% of $1,027 |
| Other | American Heritage Life Insurance Company | Deprospo Ins Consulting LLC | 1 | $5 0.5% of $1,027 |
| Universal Life | American Heritage Life Insurance Company | Kish Bank | 5 | $18 3.8% of $468 |
| Universal Life | American Heritage Life Insurance Company | Croyle Christopher A | 5 | $6 1.3% of $468 |
| Accident | American Heritage Life Insurance Company | Deprospo Jennifer | 8 | $181 7.7% of $2,365 |
| Accident | American Heritage Life Insurance Company | Kish Bank | 8 | $127 5.4% of $2,365 |
| Accident | American Heritage Life Insurance Company | Croyle Christopher A | 8 | $29 1.2% of $2,365 |
| Accident | American Heritage Life Insurance Company | Deprospo Ins Consulting LLC | 8 | $15 0.6% of $2,365 |
| Accident | American Heritage Life Insurance Company | Croyle Collette R | 8 | $9 0.4% of $2,365 |
| Cancer | American Heritage Life Insurance Company | Kish Bank | 6 | $275 9.3% of $2,961 |
| Cancer | American Heritage Life Insurance Company | Croyle Christopher A | 6 | $84 2.8% of $2,961 |
| Critical Illness | American Heritage Life Insurance Company | Deprospo Jennifer | 3 | $24 4.5% of $534 |
| Critical Illness | American Heritage Life Insurance Company | Kish Bank | 3 | $21 3.9% of $534 |
| Critical Illness | American Heritage Life Insurance Company | Croyle Collette R | 3 | $5 0.9% of $534 |
| Critical Illness | American Heritage Life Insurance Company | Deprospo Ins Consulting LLC | 3 | $2 0.4% of $534 |
| Other | American Heritage Life Insurance Company | Kish Bank | 4 | $163 5.9% of $2,764 |
| Other | American Heritage Life Insurance Company | Deprospo Jennifer | 4 | $73 2.6% of $2,764 |
| Other | American Heritage Life Insurance Company | Croyle Collette R | 4 | $18 0.7% of $2,764 |
| Other | American Heritage Life Insurance Company | Croyle Christopher A | 4 | $11 0.4% of $2,764 |
| Other | American Heritage Life Insurance Company | Deprospo Ins Consulting LLC | 4 | $10 0.4% of $2,764 |
| Hospital Indemnity | American Heritage Life Insurance Company | Kish Bank | 1 | $32 8.8% of $364 |
| Hospital Indemnity | American Heritage Life Insurance Company | Croyle Christopher A | 1 | $11 3.0% of $364 |
| Universal Life | American Heritage Life Insurance Company | Kish Bank | 6 | $102 3.6% of $2,820 |
| Universal Life | American Heritage Life Insurance Company | Croyle Christopher A | 6 | $27 1.0% of $2,820 |
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 $25,854
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group | Broker | $19,009 | $288.02 |
| Mcgriff Insurance Services | Broker | $18,600 | $281.82 |
| Capital Bluecross | Admin | $-11,755 | $-178.11 |