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Employer
89 Church Road, Emigsville, PA 17318 · EIN 11-2156739 · Jul 1, 2023 to Jun 30, 2024
Plan year 2023
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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 $7,297
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Companion Life Insurance Company | — | — | Schedule A not provided |
| Vision | National Vision Administrators, LLC (Ngl) | Brown & Brown Of Pennsylvania | 125 | $351 10.0% of $3,510 |
| Vision | Eyemed Vision Care | — | 133 | Comp not disclosed Premium $1,917 |
| Life | The Guardian Life Insurance Company Of America | Alpha Benefits Group, Inc | 79 | $4,711 15.8% of $29,866 |
| Life | The Guardian Life Insurance Company Of America | Brown & Brown Of New York | 79 | $2,195 7.3% of $29,866 |
| Life | The Guardian Life Insurance Company Of America | Financial Balance Group LLC | 79 | $40 0.1% of $29,866 |
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 $36,596
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Brown & Brown Of Pennsylvania | Broker | $13,076 | $98.32 |
| Phoenix Administrators | Admin | $13,202 | $99.26 |
| Delta Dental Of Pennsylvania | Admin | $4,625 | $34.77 |
| Phcs | Admin | $3,736 | $28.09 |
| Summit Care Management | Admin | $1,074 | $8.08 |
| Teladoc | Admin | $883 | $6.64 |