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Employer
1 Simplex Drive, Scranton, PA 18504 · EIN 23-1739146 · 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 $19,670
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Sun Life Assurance Company Of Canada | — | 85 | Comp not disclosed Premium $367,696 |
| Dental + Vision | National Guardian Life Insurance Company | Creative Benefits, Inc | 94 | $3,245 7.3% of $44,177 |
| Life | Colonial Life & Accident Insurance Company | Creative Benefits, Inc | 101 | $7,396 11.3% of $65,562 |
| Life | Colonial Life & Accident Insurance Company | Brad Lee Mundy | 101 | $3,707 5.7% of $65,562 |
| Life | Colonial Life & Accident Insurance Company | Roth Voluntary Benefit Services Inc | 101 | $3,268 5.0% of $65,562 |
| Life | Colonial Life & Accident Insurance Company | O'Neill Voluntary Benefit Services | 101 | $969 1.5% of $65,562 |
| Life | Colonial Life & Accident Insurance Company | Lauren Ashley Perri | 101 | $367 0.6% of $65,562 |
| Life | Colonial Life & Accident Insurance Company | Lisa A Perri | 101 | $310 0.5% of $65,562 |
| Life | Colonial Life & Accident Insurance Company | Nicholas Cusmano | 101 | $202 0.3% of $65,562 |
| Life | Colonial Life & Accident Insurance Company | Gustavo Tode | 101 | $115 0.2% of $65,562 |
| Life | Colonial Life & Accident Insurance Company | Michael J Perri | 101 | $91 0.1% of $65,562 |
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.
No Schedule C parties in this year.