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Employer
Po Box 218, Lahaska, PA 18931 · EIN 82-3380339 · Mar 1, 2025 to Feb 28, 2026
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 $51,384
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | United Of Omaha | Nfp Corporate Services (Pa), Inc. | 18 | $422 13.0% of $3,248 |
| Medical | United Of Omaha | Totalis Benefits Inc | 18 | $114 3.5% of $3,248 |
| Medical | United Of Omaha | James R Nelligan & Associates | 18 | $49 1.5% of $3,248 |
| Medical | United Of Omaha | Nfp Insurance Services Inc | 18 | $40 1.2% of $3,248 |
| Medical | Independence Blue Cross - Keystone | Emerson Rogers LLC | 56 | $23,667 5.6% of $422,147 |
| Medical | Independence Blue Cross | Emerson Rogers LLC | 39 | $14,308 4.1% of $346,990 |
| Medical | United Of Omaha | Nfp Corporate Services (Pa), Inc. | 10 | $144 13.8% of $1,041 |
| Medical | United Of Omaha | Totalis Benefits Inc | 10 | $34 3.3% of $1,041 |
| Medical | United Of Omaha | James R Nelligan & Associates | 10 | $18 1.7% of $1,041 |
| Medical | United Of Omaha | Nfp Insurance Services Inc | 10 | $17 1.6% of $1,041 |
| Dental + Vision | Unitedhealthcare | Nfp Corporate Services (Pa), Inc. | 125 | $2,569 5.0% of $51,380 |
| Life | United Of Omaha | Nfp Corporate Services (Pa), Inc. | 29 | $1,493 14.3% of $10,415 |
| Life | United Of Omaha | Totalis Benefits Inc | 29 | $345 3.3% of $10,415 |
| Life | United Of Omaha | Nfp Insurance Services Inc | 29 | $188 1.8% of $10,415 |
| Life | United Of Omaha | James R Nelligan & Associates | 29 | $88 0.8% of $10,415 |
| Life | United Of Omaha | Nfp Corporate Services (Pa), Inc. | 142 | $854 12.9% of $6,610 |
| Life | United Of Omaha | Totalis Benefits Inc | 142 | $224 3.4% of $6,610 |
| Life | United Of Omaha | James R Nelligan & Associates | 142 | $106 1.6% of $6,610 |
| Life | United Of Omaha | Nfp Insurance Services Inc | 142 | $80 1.2% of $6,610 |
| Other | Independence Blue Cross | — | 56 | Comp not disclosed Premium $154,993 |
| Other | United Of Omaha | Nfp Corporate Services (Pa), Inc. | 49 | $2,433 18.0% of $13,499 |
| Other | United Of Omaha | Totalis Benefits Inc | 49 | $456 3.4% of $13,499 |
| Other | United Of Omaha | James R Nelligan & Associates | 49 | $219 1.6% of $13,499 |
| Other | United Of Omaha | Nfp Insurance Services Inc | 49 | $170 1.3% of $13,499 |
| Other | United Of Omaha | Nfp Corporate Services (Pa), Inc. | 35 | $2,486 17.6% of $14,086 |
| Other | United Of Omaha | Totalis Benefits Inc | 35 | $463 3.3% of $14,086 |
| Other | United Of Omaha | James R Nelligan & Associates | 35 | $241 1.7% of $14,086 |
| Other | United Of Omaha | Nfp Insurance Services Inc | 35 | $156 1.1% of $14,086 |
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.