Employer

Lycoming Community Care, Inc.

2140 Warrensville Road, Montoursville, PA 17754 · EIN 23-2626796 · Jan 1, 2024 to Dec 31, 2024

Plan year 2024

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Schedule A

Direct compensation

Coverage contracts on the filing. If the carrier did not provide Schedule A, the row is listed with that note.

Visible subtotal $10,656

Coverage	Carrier	Broker	Lives	Direct comp
Dental	Delta Dental Of Pennsylvania	Lr Webber	104	$3,750 10.0% of $37,500
Vision	Heartland	Lr Webber	102	$755 10.0% of $7,551
Life	Oneamerica, American United Life Insurance Company	Lr Webber	125	$6,151 10.9% of $56,575

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.