Employer
J. R. Balsan, Inc. DBA Johnstone Supply
55 Country Club Drive, Ste 201, Downingtown, PA 19335 · EIN 23-2809095 · Jan 1, 2024 to Dec 31, 2024
Plan year 2024
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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 $46,658
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Dental + Vision | Guardian Life Insurance Company | Onedigital (Philadelphia) | 176 | $38,974 15.6% of $249,749 |
| Dental + Vision | Guardian Life Insurance Company | Onedigital Premier Services LLC | 176 | $4,481 1.8% of $249,749 |
| Dental + Vision | Guardian Life Insurance Company | Amerihealth Administrators, Inc. | 176 | $3,203 1.3% of $249,749 |
| Stop-loss | Avalon Insurance Company | — | 123 | Comp not disclosed Premium $308,891 |
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 $131,073
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Onedigital (Philadelphia) | Broker | $70,425 | $503.04 |
| The Benecon Group | Broker | $24,633 | $175.95 |
| Independence Administrators (Ia) | Admin | $27,470 | $196.21 |
| ConnectCare3 | Patient Advocate | $8,545 | $61.04 |