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Employer
3335 Morgantown Road, Mohnton, PA 19540 · EIN 82-3505051 · 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 $28,640
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Principal Life Insurance Company | Cbiz Benefits & Ins. Services | 169 | $2,200 3.2% of $69,002 |
| Medical | Principal Life Insurance Company | Usi Insurance Services (Ri) | 169 | $1,032 1.5% of $69,002 |
| Vision | Vision Service Plan | Cbiz Benefits & Ins. Services | 99 | $630 5.0% of $12,688 |
| Vision | Vision Service Plan | Usi Insurance Services (Ri) | 99 | $409 3.2% of $12,688 |
| Life | United Of Omaha Life Insurance Company | Cbiz Benefits & Ins. Services | 46 | $1,787 9.8% of $18,310 |
| Life | United Of Omaha Life Insurance Company | Usi Insurance Svcs LLC Mid-Atlantic | 46 | $960 5.2% of $18,310 |
| Life | United Of Omaha Life Insurance Company | Cbiz Benefits & Ins. Services | 46 | $698 3.8% of $18,310 |
| Life | United Of Omaha Life Insurance Company | Cbiz Benefits & Ins. Services | 36 | $3,276 14.0% of $23,437 |
| Life | United Of Omaha Life Insurance Company | Usi Insurance Svcs LLC - Mid-Atlant | 36 | $1,235 5.3% of $23,437 |
| Other | United Of Omaha Life Insurance Company | Cbiz Benefits & Ins. Services | 151 | $6,845 9.8% of $70,158 |
| Other | United Of Omaha Life Insurance Company | Usi Insurance Svcs LLC - Mid-Atlant | 151 | $3,679 5.2% of $70,158 |
| Other | United Of Omaha Life Insurance Company | Cbiz Benefits & Ins. Services | 151 | $2,621 3.7% of $70,158 |
| Voluntary | United Of Omaha Life Insurance Company | Cbiz Benefits & Ins. Services | 46 | $2,327 13.4% of $17,397 |
| Voluntary | United Of Omaha Life Insurance Company | Usi Insurance Svcs LLC - Mid-Atlant | 46 | $941 5.4% of $17,397 |
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 $115,169
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Meritain | Admin | $115,169 | $673.50 |