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Employer
1875 Church Road, Malvern, PA 19355 · EIN 23-2158026 · Jul 1, 2024 to Jun 30, 2025
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 $47,857
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | — | Comp not disclosed Premium $1,620 |
| Stop-loss | HM Life Insurance Company | — | 158 | Comp not disclosed Premium $821,031 |
| Dental + Vision | Guardian Life | Kistler Tiffany Benefits Co | 161 | $8,472 9.3% of $90,902 |
| Life | The Lincoln National Life Insurance Company | Kistler Tiffany Benefits Co | 185 | $965 15.0% of $6,430 |
| Life | The Lincoln National Life Insurance Company | Gis Benefits Inc | 185 | $322 5.0% of $6,430 |
| AD&D | The Lincoln National Life Insurance Company | Kistler Tiffany Benefits Co | 88 | $1,055 15.0% of $7,034 |
| AD&D | The Lincoln National Life Insurance Company | Gis Benefits Inc | 88 | $352 5.0% of $7,034 |
| Other | The Lincoln National Life Insurance Company | Kistler Tiffany Benefits Co | 111 | $6,512 15.0% of $43,414 |
| Other | The Lincoln National Life Insurance Company | Gis Benefits Inc | 111 | $2,171 5.0% of $43,414 |
| Other | The Lincoln National Life Insurance Company | Kistler Tiffany Benefits Co | 72 | $2,161 15.0% of $14,408 |
| Other | The Lincoln National Life Insurance Company | Gis Benefits Inc | 72 | $720 5.0% of $14,408 |
| Vol Life, Vol Spouse Life, Vol Child Life | The Lincoln National Life Insurance Company | Kistler Tiffany Bnfts General Agcy | 88 | $8,207 15.0% of $54,712 |
| Vol Life, Vol Spouse Life, Vol Child Life | The Lincoln National Life Insurance Company | Gis Benefits Inc | 88 | $2,736 5.0% of $54,712 |
| Accident | The Lincoln National Life Insurance Company | Kistler Tiffany Bnfts | 84 | $4,321 20.0% of $21,606 |
| Accident | The Lincoln National Life Insurance Company | Gis Benefits Inc | 84 | $1,080 5.0% of $21,606 |
| Critical Illness | The Lincoln National Life Insurance Company | Kistler Tiffany Bnfts | 52 | $3,835 20.0% of $19,173 |
| Critical Illness | The Lincoln National Life Insurance Company | Gis Benefits Inc | 52 | $959 5.0% of $19,173 |
| Hospital Indemnity | The Lincoln National Life Insurance Company | Kistler Tiffany Bnfts | 48 | $3,191 20.0% of $15,956 |
| Hospital Indemnity | The Lincoln National Life Insurance Company | Gis Benefits Inc | 48 | $798 5.0% of $15,956 |
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 $189,744
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Onedigital (Philadelphia) | Broker | $115,800 | $345.67 |
| The Benecon Group | Broker | $38,764 | $115.71 |
| Brown & Brown (Pa) | Broker | $-250 | $-0.75 |
| Independence Administrators (Ia) | Admin | $35,430 | $105.76 |