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Employer
1 Viking Street, Corry, PA 16407 · EIN 20-4960742 · 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 $66,496
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Highmark Inc | Lillis Mckibben Bongiovanni & Co (L | 122 | $33,704 2.0% of $1,714,579 |
| Vision | United Of Omaha Life Insurance Company | Lillis Mckibben Bongiovanni & Co (L | 98 | $2,402 16.2% of $14,857 |
| Vision | United Of Omaha Life Insurance Company | Professional Group Plans Inc | 98 | $484 3.3% of $14,857 |
| Life | United Of Omaha Life Insurance Company | Lillis Mckibben Bongiovanni & Co (L | 154 | $1,776 15.2% of $11,652 |
| Life | United Of Omaha Life Insurance Company | Professional Group Plans Inc | 154 | $393 3.4% of $11,652 |
| Life | United Of Omaha Life Insurance Company | Lillis Mckibben Bongiovanni & Co (L | 64 | $7,845 21.4% of $36,698 |
| Life | United Of Omaha Life Insurance Company | Professional Group Plans Inc | 64 | $1,174 3.2% of $36,698 |
| Business Travel Accident | Life Insurance Company Of North America | Lillis Mckibben Bongiovanni & Co (L | 161 | $95 10.0% of $950 |
| Other | United Of Omaha Life Insurance Company | Lillis Mckibben Bongiovanni & Co (L | 58 | $3,547 19.6% of $18,131 |
| Other | United Of Omaha Life Insurance Company | Professional Group Plans Inc | 58 | $617 3.4% of $18,131 |
| Other | United Of Omaha Life Insurance Company | Lillis Mckibben Bongiovanni & Co (L | 151 | $6,959 12.7% of $54,927 |
| Other | United Of Omaha Life Insurance Company | Professional Group Plans Inc | 151 | $1,861 3.4% of $54,927 |
| Other | United Of Omaha Life Insurance Company | Lillis Mckibben Bongiovanni & Co (L | 42 | $4,871 20.9% of $23,319 |
| Other | United Of Omaha Life Insurance Company | Professional Group Plans Inc | 42 | $768 3.3% of $23,319 |
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.