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Employer
966 S. Matlack St., West Chester, PA 19382 · EIN 73-1670629 · Jan 1, 2024 to Dec 31, 2024
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 $28,513
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Everest Reinsurance Company | — | — | Comp not disclosed Premium $5,712 |
| Stop-loss | HM Life Insurance Company | — | 82 | Comp not disclosed Premium $330,037 |
| Vision | Vision Service Plan | Onedigital (Philadelphia) | 99 | $748 7.5% of $9,968 |
| Vision | Vision Service Plan | Employee Navigator LLC | 99 | $50 0.5% of $9,968 |
| Life | United Of Omaha Life Insurance Company | Joseph Peter Bush | 151 | $1,913 8.0% of $23,912 |
| Life | United Of Omaha Life Insurance Company | American Fidelity General Agency In | 151 | $1,674 7.0% of $23,912 |
| AD&D | United Of Omaha Life Insurance Company | Joseph Peter Bush | 20 | $670 8.0% of $8,381 |
| AD&D | United Of Omaha Life Insurance Company | American Fidelity General Agency In | 20 | $587 7.0% of $8,381 |
| Cancer, Accident | American Fidelity Assurance Company | Bush, Joseph | 18 | $5,637 14.7% of $38,450 |
| Cancer, Accident | American Fidelity Assurance Company | Paa Services Inc | 18 | $311 0.8% of $38,450 |
| Cancer, Accident | American Fidelity Assurance Company | American Fidelity Assurance Company | 18 | $-525 -1.4% of $38,450 |
| Cancer, Accident | American Fidelity Assurance Company | Bush, Joseph P | 13 | $5,413 18.9% of $28,638 |
| Cancer, Accident | American Fidelity Assurance Company | Pennsylvania Auto Assoc Ins Agy Inc | 13 | $281 1.0% of $28,638 |
| Cancer, Accident | American Fidelity Assurance Company | American Fidelity Assurance Company | 13 | $-542 -1.9% of $28,638 |
| Accident, Cancer | American Fidelity Assurance Company | Bush Joseph P | 28 | $7,343 15.0% of $48,875 |
| Accident, Cancer | American Fidelity Assurance Company | Pennsylvania Auto Assoc Ins Agy Inc | 28 | $487 1.0% of $48,875 |
| Accident, Cancer | American Fidelity Assurance Company | American Fidelity Assurance Company | 28 | $339 0.7% of $48,875 |
| Other | United Of Omaha Life Insurance Company | Joseph Peter Bush | 43 | $1,159 5.3% of $21,729 |
| Other | United Of Omaha Life Insurance Company | American Fidelity General Agency In | 43 | $1,014 4.7% of $21,729 |
| Other | United Of Omaha Life Insurance Company | Joseph Peter Bush | 43 | $1,042 5.3% of $19,538 |
| Other | United Of Omaha Life Insurance Company | American Fidelity General Agency In | 43 | $912 4.7% of $19,538 |
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 $100,498
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Onedigital (Philadelphia) | Broker | $32,672 | $279.25 |
| The Benecon Group | Broker | $15,917 | $136.04 |
| Luminare Health Benefits Inc. | Admin | $46,382 | $396.43 |
| ConnectCare3 | Patient Advocate | $5,527 | $47.24 |