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Employer
Po Box 3307, Williamsport, PA 17701 · EIN 13-5609081 · Jun 1, 2020 to Jan 31, 2021
Plan year 2020
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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 $12,149
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Gerber Life Insurance Company | — | — | Schedule A not provided |
| Dental | Delta Dental Of Pennsylvania | Brown & Brown Of Pennsylvania | 118 | $3,755 6.5% of $57,770 |
| Life | The Lincoln National Life Insurance Company | Brown & Brown Of Pennsylvania | 391 | $2,310 10.0% of $23,098 |
| AD&D | The Lincoln National Life Insurance Company | Brown & Brown Of Pennsylvania | 7 | $166 10.0% of $1,658 |
| Other | The Lincoln National Life Insurance Company | Brown & Brown Of Pennsylvania | 39 | $631 10.0% of $6,306 |
| Other | The Lincoln National Life Insurance Company | Brown & Brown Of Pennsylvania | 101 | $3,258 10.0% of $32,582 |
| Voluntary Life, Spouse Life And Child Life | The Lincoln National Life Insurance Company | Brown & Brown Of Pennsylvania | 23 | $2,029 10.0% of $20,292 |
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 $124,327
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Brown & Brown Of Pennsylvania, Lp | Broker | $33,858 | $58.48 |
| Trustmark Health Benefits | Admin | $56,611 | $97.77 |
| Highmark | Admin | $33,858 | $58.48 |