Employer
Casual Living Unlimited LLC
172 Orlan Road, New Holland, PA 17557 · EIN 81-2705203 · Dec 1, 2020 to Nov 30, 2021
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 $3,673
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Everest Reinsurance Company | — | 44 | Comp not disclosed Premium $150,513 |
| Dental | Delta Dental Of Pennsylvania | Engle, Hambright & Davies, Inc. | 59 | $2,047 10.0% of $20,473 |
| Vision | Vision Benefits Of America | Engle, Hambright & Davies, Inc. | 37 | $244 8.7% of $2,793 |
| Vision | Vision Benefits Of America | Engle, Hambright & Davies, Inc. | 7 | $48 10.9% of $439 |
| Life | Assurity Life Insurance Company | Engle, Hambright & Davies, Inc. | 20 | $700 13.4% of $5,216 |
| Life | Assurity Life Insurance Company | Simkiss Agency Inc. | 20 | $634 12.2% of $5,216 |
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 $52,953
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Engle Hambright & Davies, Inc | Broker | $21,439 | $363.37 |
| The Benecon Group, LLC | Broker | $14,232 | $241.22 |
| Capital Blue Cross | Admin | $14,145 | $239.75 |
| Connectcare 3 | Patient Advocate | $3,137 | $53.17 |