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Employer
732 Fleetwood Lyons Rd, Fleetwood, PA 19522 · EIN 23-1920916 · Jan 1, 2025 to Dec 31, 2025
Plan year 2025
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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 $2,155
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 19 | Comp not disclosed Premium $93,744 |
| Dental | Colonial Life & Accident Insurance Company | Tompkins Insurance | 13 | $822 7.9% of $10,411 |
| Dental | Colonial Life & Accident Insurance Company | James Bartlett LLC | 13 | $65 0.6% of $10,411 |
| Dental | Colonial Life & Accident Insurance Company | David J Mcclellan | 13 | $55 0.5% of $10,411 |
| Dental | Colonial Life & Accident Insurance Company | Vincent J Rowan | 13 | $32 0.3% of $10,411 |
| Dental | Colonial Life & Accident Insurance Company | Melinda Diane Swartley | 13 | $28 0.3% of $10,411 |
| Dental | Colonial Life & Accident Insurance Company | Jennifer Mcclellan | 13 | $13 0.1% of $10,411 |
| Dental | Colonial Life & Accident Insurance Company | Wendy Madonna | 13 | $8 0.1% of $10,411 |
| Dental | Colonial Life & Accident Insurance Company | Gary D Davis | 13 | $5 0.0% of $10,411 |
| Dental | Colonial Life & Accident Insurance Company | Zachary Eugene Vickers | 13 | $2 0.0% of $10,411 |
| Dental | Colonial Life & Accident Insurance Company | Parks Benefits & Enrollment LLC | 13 | $2 0.0% of $10,411 |
| Dental | Colonial Life & Accident Insurance Company | Lorenzo V Cutaia | 13 | $2 0.0% of $10,411 |
| Vision | Capital Advantage Assurance Company | Tompkins Insurance | 23 | $48 4.0% of $1,204 |
| Life | Unum Life Insurance Company Of America | Tompkins Insurance | 35 | $1,073 12.3% of $8,723 |
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 $33,720
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group | Broker | $20,449 | $584.26 |
| Tompkins Insurance | Broker | $8,856 | $253.03 |
| Revivehealth, Inc. | Other | $3,211 | $91.74 |
| Capital Bluecross | Admin | $1,204 | $34.40 |