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Employer
Po Box 1050, Hermitage, PA 16148 · EIN 25-1158715 · Jan 1, 2025 to Dec 31, 2025
Plan year 2025
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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 $122,913
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | Henderson Brothers Inc. | 361 | $91,565 10.0% of $915,548 |
| Medical | Principal Life Insurance Company | Henderson Brothers Inc. | 510 | $4,311 4.3% of $99,612 |
| Medical | Principal Life Insurance Company | Centro Benefits Research LLC | 510 | $3,988 4.0% of $99,612 |
| Vision | Fidelity Security Life Insurance Company | Henderson Brothers Inc. | 451 | $2,770 11.1% of $24,889 |
| Vision | Fidelity Security Life Insurance Company | Assurex Global Corporation | 451 | $2,770 11.1% of $24,889 |
| Life | The Lincoln National Life Insurance Company | Henderson Brothers Inc. | 161 | $4,522 11.0% of $40,999 |
| Other | The Lincoln National Life Insurance Company | Henderson Brothers Inc. | 551 | $3,542 11.1% of $31,843 |
| Other | The Lincoln National Life Insurance Company | Henderson Brothers Inc. | 239 | $8,660 11.1% of $77,839 |
| Other | The Lincoln National Life Insurance Company | Henderson Brothers Inc. | 114 | $785 13.1% of $5,988 |
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 $262,415
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Highmark Inc | Claims Processor | $262,415 | $476.25 |