Employer
Grand Lodge Of Free And Accepted Masons Of Pa
One Masonic Drive, Elizabethtown, PA 17022 · EIN 23-6407467 · Jan 1, 2024 to Dec 31, 2024
Plan year 2024
Covered lives: 1997
Schedule A
Direct compensation
Coverage contracts on the filing. If the carrier did not provide Schedule A, the row is listed with that note.
Visible subtotal $138,157
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Dental | United Concordia Insurance Company | Usi Southwest | 1997 | $27,791 3.9% of $706,169 |
| Vision | Heartland | — | 1841 | Comp not disclosed Premium $128,079 |
| Life | United Of Omaha Life Insurance Company | Fmlasource, Inc. | 1353 | $22,538 26.0% of $86,594 |
| Life | United Of Omaha Life Insurance Company | Usi Southwest | 1353 | $5,562 6.4% of $86,594 |
| Life | United Of Omaha Life Insurance Company | Usi Southwest | 250 | $7,659 5.5% of $139,516 |
| AD&D | Mutual Of Omaha Insurance Company | Usi Southwest | 229 | $621 6.3% of $9,865 |
| Other | United Of Omaha Life Insurance Company | Usi Southwest | 997 | $13,637 6.3% of $215,496 |
| Other | United Of Omaha Life Insurance Company | Usi Southwest | 427 | $30,491 19.1% of $159,420 |
| Other | United Of Omaha Life Insurance Company | — | 427 | Comp not disclosed Premium $159,420 |
| Critical Illness | United Of Omaha Life Insurance Company | Usi Southwest | 203 | $19,445 22.0% of $88,584 |
| Accident Only | United Of Omaha Life Insurance Company | Usi Southwest | 190 | $10,413 22.2% of $46,920 |
Schedule C
Additional compensation
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.
No Schedule C parties in this year.