Employer
Jg Environmental, LLC
202 Greenfield Rd, Lancaster, PA 17601 · EIN 32-0236877 · Jan 1, 2022 to Dec 31, 2022
Plan year 2022
Covered lives: 62
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 $4,313
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Everest Reinsurance Company | — | 47 | Comp not disclosed Premium $134,879 |
| Dental + Vision | Capital Advantage Assurance Company | Engle Hambright & Davies, Inc. | 62 | $2,271 9.2% of $24,815 |
| Life | Standard Insurance Company | Engle Hambright & Davies, Inc. | 44 | $228 13.8% of $1,657 |
| Other | Standard Insurance Company | Engle Hambright & Davies, Inc. | 44 | $1,202 13.8% of $8,718 |
| Other | Standard Insurance Company | Engle Hambright & Davies, Inc. | 30 | $612 9.7% of $6,308 |
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 $86,039
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Engle Hambright & Davies, Inc. | Broker | $14,213 | $229.24 |
| The Benecon Group, LLC | Broker | $9,726 | $156.87 |
| Capital Blue Cross | Admin | $59,883 | $965.85 |
| Connectcare 3 | Patient Advocate | $2,217 | $35.76 |