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Employer
30 Glade Run Drive, Zelienople, PA 16063 · EIN 25-0974320 · 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 $1,210
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 155 | Comp not disclosed Premium $569,704 |
| Vision | Eyemed Vision Care | — | 264 | Comp not disclosed Premium $22,104 |
| Life | Reliance Standard Life Insurance Company | Henderson Brothers Inc. | 240 | $209 2.2% of $9,484 |
| Life | Reliance Standard Life Insurance Company | Watchtower Technologies Inc | 240 | $143 1.5% of $9,484 |
| Other | Reliance Standard Life Insurance Company | Henderson Brothers Inc. | 240 | $492 2.0% of $24,368 |
| Other | Reliance Standard Life Insurance Company | Watchtower Technologies Inc | 240 | $366 1.5% of $24,368 |
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 $145,049
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group, LLC | Broker | $37,025 | $238.87 |
| Healthnow | Admin | $84,134 | $542.80 |
| ConnectCare3 | Patient Advocate | $10,296 | $66.43 |
| Epiphanyrx | Admin | $3,445 | $22.23 |
| Delta Dental Of Pennsylvania | Admin | $10,149 | $36.25 |