Employer
Mellott Company
100 Mellott Dr., Ste. 100, Warfordsburg, PA 17267 · EIN 23-1415787 · Jan 1, 2025 to Dec 31, 2025
Plan year 2025
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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 $102,999
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Dental | Delta Dental Of Pennsylvania | Hilb Group Of Maryland | 541 | $11,017 6.9% of $158,527 |
| Vision | Eyemed Vision Care | Hilb Group Of Maryland | 488 | $2,170 7.6% of $28,535 |
| Life | The Guardian Life Insurance Company Of America | Hilb Group Of Maryland | 343 | $89,812 23.5% of $382,386 |
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 $1,299,230
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Hilb Group Of Maryland | Broker | $110,426 | $204.11 |
| Hcc Life Insurance | Reinsurance Carrier | $1,021,015 | $1,887.27 |
| Carefirst Administrators | Third Party Admin | $162,740 | $300.81 |
| Mdlive | Teleheath | $4,102 | $7.58 |
| Conifer Valued-Based Care | Utilization Management | $947 | $1.75 |