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Employer
1406 Peach Street, Erie, PA 16501 · EIN 16-1570188 · Apr 1, 2024 to Mar 31, 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 $171,430
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Aetna Life Insurance Co. | Lillis Mckibben Bongiovanni & Co (L | 664 | $111,433 3.1% of $3,574,268 |
| Medical | University Health Alliance | Atlas Insurance Agency Inc | 4 | $1,695 5.0% of $34,035 |
| Dental | Delta Dental Of Pennsylvania | Lillis Mckibben Bongiovanni & Co (L | 392 | $8,602 5.0% of $172,048 |
| Vision | Vision Benefits Of America | Lillis Mckibben Bongiovanni & Co (L | 375 | $1,297 5.0% of $25,942 |
| Life | United Of Omaha Life Insurance Company | Lillis Mckibben Bongiovanni & Co (L | 452 | $3,279 16.3% of $20,099 |
| Life | United Of Omaha Life Insurance Company | Professional Group Plans Inc | 452 | $923 4.6% of $20,099 |
| AD&D | United Of Omaha Life Insurance Company | Lillis Mckibben Bongiovanni & Co (L | 226 | $13,525 21.2% of $63,773 |
| AD&D | United Of Omaha Life Insurance Company | Professional Group Plans Inc | 226 | $2,935 4.6% of $63,773 |
| Voluntary Critical Illness | United Of Omaha Life Insurance Company | Lillis Mckibben Bongiovanni & Co (L | 152 | $5,118 21.3% of $23,995 |
| Voluntary Critical Illness | United Of Omaha Life Insurance Company | Professional Group Plans Inc | 152 | $1,097 4.6% of $23,995 |
| Voluntary Accident Only | United Of Omaha Life Insurance Company | Lillis Mckibben Bongiovanni & Co (L | 145 | $5,101 21.3% of $23,895 |
| Voluntary Accident Only | United Of Omaha Life Insurance Company | Professional Group Plans Inc | 145 | $1,099 4.6% of $23,895 |
| Other | United Of Omaha Life Insurance Company | Lillis Mckibben Bongiovanni & Co (L | 465 | $6,914 14.6% of $47,246 |
| Other | United Of Omaha Life Insurance Company | Fmlasource Inc | 465 | $6,204 13.1% of $47,246 |
| Other | United Of Omaha Life Insurance Company | Professional Group Plans Inc | 465 | $2,158 4.6% of $47,246 |
| Agb Worldtraveler | Aetna International | Lillis Mckibben Bongiovanni & Co (L | 5 | $50 5.0% of $1,000 |
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.