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Employer
Po Box 885, Lansdale, PA 19446 · EIN 23-0564020 · Dec 1, 2021 to Nov 30, 2022
Plan year 2021
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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 $16,016
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Everest Reinsurance Company | — | 54 | Comp not disclosed Premium $25,655 |
| Dental | United Concordia Insurance Company | Kistler Tiffany Benefits Co | 74 | $3,376 9.9% of $33,963 |
| Life | Madison National Life Insurance Company | Thomas J Ingelsby | 65 | $1,874 8.9% of $21,139 |
| Life | Madison National Life Insurance Company | William O. Daggett Jr | 65 | $766 3.6% of $21,139 |
| Life | Madison National Life Insurance Company | Kt Holding Co, Inc. | 65 | $212 1.0% of $21,139 |
| Life | One America | Thomas J Ingelsby | 65 | $2,761 39.9% of $6,912 |
| Life | One America | Nabco | 65 | $1,642 23.8% of $6,912 |
| Life | One America | William O. Daggett Jr | 65 | $1,215 17.6% of $6,912 |
| Life | One America | Kt Holdcoinc | 65 | $554 8.0% of $6,912 |
| Other | Kansas City Life Insurance Company | Thomas J. Ingelsby | 21 | $2,216 10.1% of $22,040 |
| Other | Kansas City Life Insurance Company | William O. Daggett Jr. | 21 | $959 4.4% of $22,040 |
| Other | Kansas City Life Insurance Company | Kt Holding Co., Inc. | 21 | $441 2.0% of $22,040 |
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 $371,085
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Digital Insurance (Kop) | Broker | $26,870 | $363.11 |
| The Benecon Group | Broker | $12,248 | $165.51 |
| Optum Health | Other | $305,671 | $4,130.69 |
| Aetna | Admin | $22,836 | $308.59 |
| Connectcare 3 | Patient Advocate | $3,460 | $46.76 |