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Employer
P.O. Box 2955, Harrisburg, PA 17105 · EIN 42-6633905 · 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 $1,742,817
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | American Fidelity Assurance Company | American Fidelity Assurance Company | 7243 | $822,896 7.0% of $11,672,357 |
| Medical | American Fidelity Assurance Company | Pennsylvania Auto Assoc Ins Agy Inc | 7243 | $642,580 5.5% of $11,672,357 |
| Medical | American Fidelity Assurance Company | Hr Advantage LLC | 7243 | $32,954 0.3% of $11,672,357 |
| Medical | American Fidelity Assurance Company | Benefit Watch Inc | 7243 | $32,940 0.3% of $11,672,357 |
| Medical | American Fidelity Assurance Company | Big Oak Insurance Services | 7243 | $32,530 0.3% of $11,672,357 |
| Medical | American Fidelity Assurance Company | Gallagher Fiduciary Advisors, LLC | 7243 | $30,939 0.3% of $11,672,357 |
| Medical | American Fidelity Assurance Company | Mads Ins Agcy Inc | 7243 | $16,015 0.1% of $11,672,357 |
| Medical | American Fidelity Assurance Company | Bush, Joseph P | 7243 | $12,472 0.1% of $11,672,357 |
| Medical | American Fidelity Assurance Company | Collegeville Financial Group LLC | 7243 | $12,168 0.1% of $11,672,357 |
| Medical | American Fidelity Assurance Company | Marsh & Mclennan Agency, LLC East | 7243 | $11,277 0.1% of $11,672,357 |
| Medical | American Fidelity Assurance Company | Marsh & Mclennan Agency, LLC East | 7243 | $9,701 0.1% of $11,672,357 |
| Medical | American Fidelity Assurance Company | George R Violand | 7243 | $3,396 0.0% of $11,672,357 |
| Medical | American Fidelity Assurance Company | Nj Car Services, Inc. | 7243 | $2,193 0.0% of $11,672,357 |
| Medical | American Fidelity Assurance Company | Supplemental Benefits Services Inc | 7243 | $1,833 0.0% of $11,672,357 |
| Medical | American Fidelity Assurance Company | Myers Beaver & Vellone Ins Agy Inc | 7243 | $427 0.0% of $11,672,357 |
| Medical | American Fidelity Assurance Company | Marsh & Mclennan Agency, LLC East | 7243 | $355 0.0% of $11,672,357 |
| Medical | American Fidelity Assurance Company | Smith, Steven O | 7243 | $248 0.0% of $11,672,357 |
| Medical | American Fidelity Assurance Company | Cbiz Benefits & Ins. Services | 7243 | $174 0.0% of $11,672,357 |
| Medical | American Fidelity Assurance Company | Roche Financial Inc | 7243 | $162 0.0% of $11,672,357 |
| Medical | American Fidelity Assurance Company | Smith Graves Associates Inc | 7243 | $-25 0.0% of $11,672,357 |
| Vision | Metropolitan Life Insurance Company | Pennsylvania Automotive Association | 9048 | $48,950 6.0% of $815,833 |
| Life | Prudential Insurance Company Of America | Pennsylvania Auto Assoc Ins Agy Inc | 4771 | $18,525 5.5% of $336,845 |
| Life | Prudential Insurance Company Of America | Emerson Reid & Co Inc | 4771 | $10,107 3.0% of $336,845 |
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 $86,770
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Boyer & Ritter | None | $44,500 | $2.40 |
| Pnc Bank | None | $26,070 | $1.41 |
| Conrad Siegel | None | $16,200 | $0.87 |