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Employer
5010 River Rd, Mount Bethel, PA 18343 · EIN 22-2057138 · Jan 1, 2025 to Dec 31, 2025
Plan year 2025
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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 $463,104
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Cigna Health And Life Insurance Company | Usi Insurance Services (Ri) | 694 | $362,927 27.5% of $1,322,075 |
| Vision | Vision Service Plan | Usi Insurance Services (Ri) | 277 | $2,848 10.0% of $28,482 |
| Life | United Of Omaha Life Insurance Company | Usi Insurance Services (Ri) | 285 | $26,143 18.2% of $143,979 |
| Life | United Of Omaha Life Insurance Company | Usi Insurance Services (Ri) | 113 | $3,320 10.0% of $33,197 |
| Other | United Of Omaha Life Insurance Company | Usi Insurance Services (Ri) | 285 | $16,848 18.1% of $93,314 |
| Other | United Of Omaha Life Insurance Company | Usi Insurance Services (Ri) | 285 | $39,323 18.1% of $217,818 |
| Accidental Injury | Cigna Health And Life Insurance Company | Usi Insurance Services (Ri) | 72 | $3,521 18.3% of $19,221 |
| Voluntary Critical Illness | Cigna Health And Life Insurance Company | Usi Insurance Services (Ri) | 61 | $5,088 18.2% of $27,917 |
| Hospital Care | Cigna Health And Life Insurance Company | Usi Insurance Services (Ri) | 53 | $3,086 18.3% of $16,855 |
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.
No Schedule C parties in this year.