Employer
Adelphoi Usa, Inc.
354 Main Street, Latrobe, PA 15650 · EIN 25-1847445 · Jan 1, 2020 to Dec 31, 2020
Plan year 2020
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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 $86,304
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Highmark | The Hdh Group, Inc. | 860 | $77,072 2.2% of $3,466,671 |
| Vision | Vision Benefits Of America | The Hdh Group, Inc. | 582 | $1,774 3.2% of $55,243 |
| Life | Reliance Standard Life Insurance Company | The Hdh Group, Inc. | 580 | $2,913 6.3% of $46,585 |
| Other | Reliance Standard Life Insurance Company | The Hdh Group, Inc. | 488 | $4,545 8.5% of $53,272 |
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.
Visible subtotal $43,279
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| United Concordia Companies, Inc. | Claims Processor | $43,279 | $50.32 |