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Employer
13374 Boot Jack Road, Ridgway, PA 15853 · EIN 52-2303015 · 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 $25,304
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 79 | Comp not disclosed Premium $424,811 |
| Dental | Sun Life Assurance Company Of Canada | Engle, Hambright & Davies, Inc. | 103 | $16,163 14.2% of $113,529 |
| Dental | Sun Life Assurance Company Of Canada | National Enrollment Partners Gen. | 103 | $5,190 4.6% of $113,529 |
| Dental | Sun Life Assurance Company Of Canada | Mercer (Us), Inc. | 103 | $2,329 2.1% of $113,529 |
| Vision | Vision Benefits Of America | Engle, Hambright & Davies, Inc. | 80 | $1,087 10.1% of $10,815 |
| Vision | Vision Benefits Of America | Benechoice Enrollment Solutions | 80 | $535 4.9% of $10,815 |
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 $76,785
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Engle-Hambright & Davies, Inc | Broker | $30,353 | $294.69 |
| The Benecon Group, LLC | Broker | $18,679 | $181.35 |
| Highmark West | Admin | $22,476 | $218.21 |
| Connectcare 3 | Patient Advocate | $5,277 | $51.23 |