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Employer
2100 Wharton Street, Pittsburgh, PA 15203 · EIN 82-1080209 · Jul 1, 2024 to Jun 30, 2025
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 $23,303
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Dental + Vision | Reliance Standard Life Insurance Company | Henderson Brothers Inc. | 490 | $4,330 2.2% of $196,017 |
| Life | Reliance Standard Life Insurance Company | Henderson Brothers Inc. | 233 | $3,857 9.6% of $40,295 |
| Voluntary Hospital Indemnity | Reliance Standard Life Insurance Company | Henderson Brothers Inc. | 49 | $1,013 7.8% of $12,946 |
| Other | Reliance Standard Life Insurance Company | Henderson Brothers Inc. | 232 | $3,679 15.8% of $23,232 |
| Voluntary Accident | Reliance Standard Life Insurance Company | Henderson Brothers Inc. | 68 | $1,781 12.5% of $14,296 |
| Voluntary Critical Illness | Reliance Standard Life Insurance Company | Henderson Brothers Inc. | 77 | $2,737 13.0% of $21,000 |
| Voluntary Short Term Disability | Reliance Standard Life Insurance Company | Henderson Brothers Inc. | 263 | $3,962 19.1% of $20,791 |
| Other | Reliance Standard Life Insurance Company | Henderson Brothers Inc. | 279 | $1,944 15.0% of $12,963 |
| Stop-loss | HM Life Insurance Company | — | 207 | Comp not disclosed Premium $626,617 |
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 $268,419
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Henderson Brothers, Inc. | Broker | $52,058 | $251.49 |
| The Benecon Group, LLC | Broker | $47,390 | $228.94 |
| Highmark West | Admin | $155,951 | $753.39 |
| ConnectCare3 | Patient Advocate | $12,862 | $62.14 |
| Highmark Blue Shield (Central) | Admin | $158 | $0.76 |