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Employer
P.O. Box 2955, Harrisburg, PA 17105 · EIN 20-6051638 · Jan 1, 2025 to Dec 31, 2025
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 $389,067
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | American Fidelity Assurance Company | American Fidelity Assurance Company | 1617 | $183,704 7.0% of $2,605,755 |
| Medical | American Fidelity Assurance Company | Pennsylvania Auto Assoc Ins Agy Inc | 1617 | $143,451 5.5% of $2,605,755 |
| Medical | American Fidelity Assurance Company | Hr Advantage LLC | 1617 | $7,356 0.3% of $2,605,755 |
| Medical | American Fidelity Assurance Company | Benefit Watch Inc | 1617 | $7,353 0.3% of $2,605,755 |
| Medical | American Fidelity Assurance Company | Big Oak Insurance Services | 1617 | $7,262 0.3% of $2,605,755 |
| Medical | American Fidelity Assurance Company | Gallagher Fiduciary Advisors, LLC | 1617 | $6,907 0.3% of $2,605,755 |
| Medical | American Fidelity Assurance Company | Mads Ins Agcy Inc | 1617 | $3,575 0.1% of $2,605,755 |
| Medical | American Fidelity Assurance Company | Bush, Joseph P | 1617 | $2,784 0.1% of $2,605,755 |
| Medical | American Fidelity Assurance Company | Collegeville Financial Group LLC | 1617 | $2,717 0.1% of $2,605,755 |
| Medical | American Fidelity Assurance Company | Marsh & Mclennan Agency, LLC East | 1617 | $2,517 0.1% of $2,605,755 |
| Medical | American Fidelity Assurance Company | Marsh & Mclennan Agency, LLC East | 1617 | $2,166 0.1% of $2,605,755 |
| Medical | American Fidelity Assurance Company | George R Violand | 1617 | $758 0.0% of $2,605,755 |
| Medical | American Fidelity Assurance Company | Nj Car Services, Inc. | 1617 | $490 0.0% of $2,605,755 |
| Medical | American Fidelity Assurance Company | Supplemental Benefit Services Inc | 1617 | $409 0.0% of $2,605,755 |
| Medical | American Fidelity Assurance Company | Myers Beaver & Vellone Ins Agy Inc | 1617 | $95 0.0% of $2,605,755 |
| Medical | American Fidelity Assurance Company | Marsh & Mclennan Agency, LLC East | 1617 | $79 0.0% of $2,605,755 |
| Medical | American Fidelity Assurance Company | Smith, Steven O | 1617 | $56 0.0% of $2,605,755 |
| Medical | American Fidelity Assurance Company | Cbiz Benefits & Ins. Services | 1617 | $39 0.0% of $2,605,755 |
| Medical | American Fidelity Assurance Company | Roche Financial Inc | 1617 | $36 0.0% of $2,605,755 |
| Medical | American Fidelity Assurance Company | Smith Graves Associates Inc | 1617 | $-6 0.0% of $2,605,755 |
| Vision | Metropolitan Life Insurance Company | Pennsylvania Automotive Association | 2020 | $10,928 6.0% of $182,128 |
| Life | Prudential Insurance Company Of America | Pennsylvania Auto Assoc Ins Agy Inc | 1065 | $4,135 5.5% of $75,198 |
| Life | Prudential Insurance Company Of America | Emerson Reid & Co Inc | 1065 | $2,256 3.0% of $75,198 |
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.