Employer
Hursh Painting Co., Inc.
Po Box 40, Brownstown, PA 17508 · EIN 23-2309300 · Dec 1, 2023 to Nov 30, 2024
Plan year 2023
Covered lives: 28
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 $4,304
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optumhealth | — | 21 | Comp not disclosed Premium $84,748 |
| Dental | Sun Life Assurance Company Of Canada | Heritage Insurance Associates | 28 | $4,160 9.1% of $45,917 |
| Dental | Sun Life Assurance Company Of Canada | Nfp Corporate Service | 28 | $144 0.3% of $45,917 |
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 $15,507
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group | Broker | $6,516 | $232.71 |
| Iag, Inc. | Broker | $6,096 | $217.71 |
| Capital Bluecross | Admin | $1,524 | $54.43 |
| Connectcare 3 | Patient Advocate | $1,371 | $48.96 |