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Employer
1985 Montour Blvd., Danville, PA 17821 · EIN 23-1975677 · 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 $51,299
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Capital Advantage Assurance Company | Brown & Brown Of Pennsylvania | 218 | $38,511 2.7% of $1,404,340 |
| Dental | Delta Dental Of Pennsylvania | Brown & Brown Of Pennsylvania | 198 | $5,753 10.0% of $57,532 |
| Vision | Vision Benefits Of America | Brown & Brown Of Pennsylvania | 97 | $737 5.0% of $14,741 |
| Life | Life Insurance Company Of North America | — | — | Schedule A not provided |
| Life | Life Insurance Company Of North America | — | — | Schedule A not provided |
| AD&D | Life Insurance Company Of North America | — | — | Schedule A not provided |
| AD&D | Life Insurance Company Of North 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 |
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | — | Comp not disclosed Premium $3,612 |
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 $2,469
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group, LLC | Broker | $2,364 | $23.18 |
| Brown & Brown Of Pa | Broker | $105 | $1.03 |