Employer
A. J. Blosenski, Inc.
1600 Chestnut Tree Road, Honey Brook, PA 19344 · EIN 23-2785764 · Jan 1, 2022 to Sep 30, 2022
Plan year 2022
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Schedule A
Direct compensation
Coverage contracts on the filing. If the carrier did not provide Schedule A, the row is listed with that note.
Visible subtotal $18,606
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Dental | Sun Life Assurance Company Of Canada | Digital Insurance, Inc. | 250 | $18,606 9.7% of $191,958 |
| Vision | Vision Benefits Of America | — | 162 | Comp not disclosed Premium $16,130 |
Schedule C
Additional compensation
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.