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Employer
Po Box 1420, Wilkes-Barre, PA 18701 · EIN 23-2024270 · 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.
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Highmark Inc. | — | 2516 | Comp not disclosed Premium $11,317,827 |
| Medical | Highmark Inc. | — | 78 | Comp not disclosed Premium $682,133 |
| Medical | Capital Blue Cross | — | 902 | Comp not disclosed Premium $10,014,314 |
| Dental | United Concordia Companies, Inc. | — | 548 | Comp not disclosed Premium $237,598 |
| Dental | United Concordia Companies, Inc. | — | 78 | Comp not disclosed Premium $27,024 |
| Life | Guardian Life Insurance | — | 903 | Comp not disclosed Premium $162,537 |
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 $428,526
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Dawn Hazeltine | Employee | $120,793 | $48.01 |
| Pnc Institutional Investments | None | $82,619 | $32.84 |
| Foster & Foster Consulting Actuarie | None | $82,542 | $32.81 |
| Bridgeway Benefit Technology | None | $47,593 | $18.92 |
| Delta Dental Of Pennsylvania | None | $37,156 | $14.77 |
| Novak Francella, LLC | None | $30,323 | $12.05 |
| Xpan Law Partners LLC | None | $27,500 | $10.93 |