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Employer
101 Power Blvd, Archbald, PA 18403 · EIN 83-2286197 · 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 $28,399
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Everest Coinsurance Company | — | — | Comp not disclosed Premium $771 |
| Stop-loss | HM Life Insurance Company | — | 121 | Comp not disclosed Premium $384,737 |
| Dental | Metropolitan Life Insurance Company | — | — | Schedule A not provided |
| Dental | Metropolitan Life Insurance Company | — | — | Schedule A not provided |
| Dental | Metropolitan Life Insurance Company | — | — | Schedule A not provided |
| Vision | Eyemed Vision Care | Patriot Growth Insurance Services L | 183 | $1,488 10.9% of $13,620 |
| Life | United Of Omaha Life Insurance Company | Patriot Growth Insurance Svcs | 146 | $4,118 15.0% of $27,388 |
| Life | United Of Omaha Life Insurance Company | Gi George Parent Lp | 146 | $394 1.4% of $27,388 |
| Other | United Of Omaha Life Insurance Company | Patriot Growth Insurance Svcs LLC | 146 | $6,552 15.0% of $43,616 |
| Other | United Of Omaha Life Insurance Company | Gi George Parent Lp | 146 | $626 1.4% of $43,616 |
| Other | United Of Omaha Life Insurance Company | United Of Omaha Life Insurance Comp | 146 | $5,172 |
| Other | United Of Omaha Life Insurance Company | Patriot Growth Insurance Svcs LLC | 146 | $364 |
| Other | United Of Omaha Life Insurance Company | Gi George Parent Lp | 146 | $104 |
| Voluntary Term Life | United Of Omaha Life Insurance Company | Patriot Growth Insurance Svcs LLC | 49 | $3,764 16.9% of $22,322 |
| Voluntary Term Life | United Of Omaha Life Insurance Company | Gi George Parent Lp | 49 | $438 2.0% of $22,322 |
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 $112,834
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Patriot (Exude, Inc.) | Broker | $48,930 | $404.38 |
| The Benecon Group | Broker | $21,595 | $178.47 |
| Highmark Bcbs Nepa | Admin | $34,807 | $287.66 |
| ConnectCare3 | Patient Advocate | $7,502 | $62.00 |