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Employer
5340 Fryling Rd, Suite 100, Erie, PA 16510 · EIN 25-1577831 · Jan 1, 2024 to Dec 31, 2024
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 $5,653
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 67 | Comp not disclosed Premium $535,432 |
| Vision | Vision Benefits Of America | Lillis Mckibben Bongiovanni & Compa | 73 | $251 3.0% of $8,395 |
| Life | Life Insurance Company Of North America | — | — | Schedule A not provided |
| AD&D | Life Insurance Company Of America | — | — | Schedule A not provided |
| Other | Life Insurance Company Of North America | — | — | Schedule A not provided |
| Other | Life Insurance Company Of North America | — | — | Schedule A not provided |
| EAP | Workpartners | — | 316 | Schedule A not provided |
| Business Travel Accident | Hartford Life And Accident | — | — | Schedule A not provided |
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 $59,260
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Lillis Mckibben Bongiovanni & Co (L | Broker | $21,609 | $251.27 |
| The Benecon Group | Broker | $16,639 | $193.48 |
| ConnectCare3 | Patient Advocate | $5,626 | $65.42 |
| Highmark West | Admin | $531 | $6.17 |
| United Concordia Companies Inc | Admin | $14,855 | $40.81 |