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Employer
2849 Big Road, Zieglerville, PA 19492 · EIN 23-1382402 · Dec 1, 2023 to Nov 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 $20,968
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optum Health Unimerica Insurance Company | Lr Webber | — | $8,597 1.9% of $458,796 |
| Dental | Delta Dental Of Pennsylvania | The Benecon Group, Inc. | — | $2,014 5.6% of $35,783 |
| Dental | Delta Dental Of Pennsylvania | Lr Webber | — | $1,565 4.4% of $35,783 |
| Life | Life Insurance Company Of North America | Marsh & Mclennan Agency, LLC East | — | $780 12.0% of $6,508 |
| Life | Life Insurance Company Of North America | Lr Webber | — | $371 5.7% of $6,508 |
| AD&D | Life Insurance Company Of North America | Marsh & Mclennan Agency, LLC East | — | $124 11.1% of $1,116 |
| AD&D | Life Insurance Company Of North America | Lr Webber | — | $64 5.7% of $1,116 |
| Other | Life Insurance Company Of North America | Marsh & Mclennan Agency, LLC East | — | $1,690 12.1% of $14,014 |
| Other | Life Insurance Company Of North America | Lr Webber | — | $793 5.7% of $14,014 |
| Other | Life Insurance Company Of North America | Marsh & Mclennan Agency, LLC East | — | $4,743 12.1% of $39,330 |
| Other | Life Insurance Company Of North America | Lr Webber | — | $227 0.6% of $39,330 |
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 $75,186
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group LLC | Broker | $23,617 | $236.17 |
| Lr Webber | Broker | $9,213 | $92.13 |
| Independence Administrators | Admin | $37,732 | $377.32 |
| Connectcare 3 | Patient Advocate | $4,624 | $46.24 |