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Employer
909 Troupe Rd, Harborcreek, PA 16421 · EIN 25-1032274 · Oct 1, 2024 to Sep 30, 2025
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 $38,980
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Symetra Life Insurance Company | Frissora & Associates, LLC | 167 | $18,496 4.0% of $462,392 |
| Dental | Delta Dental | Frissora & Associates, LLC | 240 | Comp not disclosed |
| Vision | Vision Benefits Of America | Frissora & Associates, LLC | 243 | Comp not disclosed Premium $26,894 |
| Life | United Of Omaha Life Insurance Company | Professional Group Plans Inc | 91 | $1,711 5.0% of $34,224 |
| Life | United Of Omaha Life Insurance Company | Seubert & Associates | 91 | $8,619 25.2% of $34,224 |
| Other | United Of Omaha Life Insurance Company | Professional Group Plans | 43 | $951 5.0% of $19,012 |
| Other | United Of Omaha Life Insurance Company | Seubert & Associates | 43 | $940 4.9% of $19,012 |
| Other | United Of Omaha Life Insurance Company | Professional Group Plans Inc | 163 | $2,116 5.0% of $42,316 |
| Other | United Of Omaha Life Insurance Company | Seubert & Associates | 163 | $6,147 14.5% of $42,316 |
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 $69,343
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Frissora & Associates | None | $35,984 | $148.08 |
| Meritain Health | None | $21,119 | $86.91 |
| Amca | None | $12,240 | $50.37 |