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Employer
321 North Front Street, Phillipsburg, PA 16866 · EIN 25-1753726 · Jan 1, 2024 to Dec 31, 2024
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 $26,909
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Everest Reinsurance Company | — | — | Comp not disclosed Premium $2,951 |
| Stop-loss | HM Life Insurance Company | — | 70 | Comp not disclosed Premium $307,750 |
| Dental | Delta Dental Of Pennsylvania | Susan Shildt | 122 | $2,671 6.0% of $44,512 |
| Vision | Highmark | The Hdh Group, Inc. | 116 | $85 3.0% of $2,813 |
| Life | United Of Omaha Life Insurance Company | The Hdh Group, Inc. | 206 | $620 15.0% of $4,135 |
| Life | United Of Omaha Life Insurance Company | The Hdh Group, Inc. | 206 | $237 5.7% of $4,135 |
| Voluntary Life | United Of Omaha Life Insurance Company | The Hdh Group, Inc. | 67 | $2,958 15.0% of $19,723 |
| Voluntary Life | United Of Omaha Life Insurance Company | The Hdh Group, Inc. | 67 | $1,256 6.4% of $19,723 |
| Voluntary Long Term Disability | United Of Omaha Life Insurance Company | The Hdh Group, Inc. | 76 | $6,398 15.0% of $42,654 |
| Voluntary Long Term Disability | United Of Omaha Life Insurance Company | The Hdh Group, Inc. | 76 | $2,636 6.2% of $42,654 |
| Other | United Of Omaha Life Insurance Company | The Hdh Group, Inc. | 206 | $6,572 10.0% of $65,715 |
| Other | United Of Omaha Life Insurance Company | The Hdh Group, Inc. | 206 | $3,476 5.3% of $65,715 |
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 $28,367
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Engle-Hambright & Davies, Inc. | Broker | $23,580 | $274.19 |
| The Benecon Group | Broker | $18,342 | $213.28 |
| Hub Int. (Pa) | Broker | $-240 | $-2.79 |
| ConnectCare3 | Patient Advocate | $5,105 | $59.36 |
| Capital Bluecross | Admin | $-18,420 | $-214.19 |