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Employer
2206 Horseshoe Pike, Honey Brook, PA 19344 · EIN 23-2564014 · Jan 1, 2020 to Dec 31, 2020
Plan year 2020
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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 $14,497
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Everest Reinsurance Company | — | 77 | Comp not disclosed Premium $261,314 |
| Dental | Metropolitan Life Insurance Company | Kistler Tiffany Benefits Co | 170 | $2,485 6.2% of $40,113 |
| Dental | Metropolitan Life Insurance Company | Kistler Tiffany Benefits Co | 170 | $780 1.9% of $40,113 |
| Life | United Of Omaha Life Insurance Company | Patriot (Power-Kunkle Group, Inc.) | 166 | $2,517 15.4% of $16,396 |
| AD&D | United Of Omaha Life Insurance Company | Patriot (Power-Kunkle Group, Inc.) | 16 | $1,741 21.3% of $8,190 |
| Other | United Of Omaha Life Insurance Company | Patriot (Power-Kunkle Group, Inc.) | 166 | $4,300 15.3% of $28,072 |
| Other | United Of Omaha Life Insurance Company | Patriot (Power-Kunkle Group, Inc.) | 166 | $2,674 15.3% of $17,496 |
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 $81,534
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Power Kunkle Group, Inc. | Broker | $24,656 | $320.21 |
| The Benecon Group | Broker | $16,803 | $218.22 |
| Meritain Health | Admin | $35,383 | $459.52 |
| Connectcare 3 | Patient Advocate | $4,692 | $60.94 |