Employer
Hempt Bros., Inc.
P.O. Box 278, Camp Hill, PA 17011 · EIN 23-1509517 · Apr 1, 2020 to Mar 31, 2021
Plan year 2020
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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 $9,644
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Aetna Life Insurance Co. | K R Macdonald Inc. | 45 | $3,910 3.0% of $132,038 |
| Dental + Vision | Highmark | Mcconkey Benefits & Financial Servi | 119 | $1,309 2.0% of $65,522 |
| Life | Dearborn National Life Insurance Company | K R Macdonald Incorporated | 99 | $3,768 13.2% of $28,602 |
| Life | Dearborn National Life Insurance Company | Consolidated Benefits Inc | 99 | $657 2.3% of $28,602 |
| Stop-loss | Everest Reinsurance Company | — | 100 | Comp not disclosed Premium $397,442 |
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.
Visible subtotal $68,529
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Mcconkey Benefits & Financial Serv | Broker | $31,743 | $291.22 |
| The Benecon Group, LLC | Broker | $7,047 | $64.65 |
| Capital Blue Cross | Admin | $23,274 | $213.52 |
| Benefitmall | Admin | $6,465 | $59.31 |