Employer
Phillips Mushroom Farms, L.P.
1011 Kaolin Road, Kennett Square, PA 19348 · EIN 23-1630612 · 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 $34,076
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Dental | United Concordia Insurance Company | Assured Partners (Central Pa) | 253 | $10,710 9.5% of $112,548 |
| Vision | Unitedhealthcare Insurance Company | Assured Partners (Central Pa) | 356 | $2,144 10.0% of $21,438 |
| Life | Reliance Standard Life Insurance Company | Assured Partners (Central Pa) | 725 | $2,472 10.0% of $24,720 |
| Supplemental Life | Reliance Standard | Assured Partners (Central Pa) | 166 | $4,326 10.0% of $43,262 |
| Other | Reliance Standard | Assured Partners (Central Pa) | 106 | $3,192 8.0% of $39,898 |
| Vol. Accident | Reliance Standard Life Insurance Company | Assured Partners (Central Pa) | 193 | $6,594 20.0% of $32,967 |
| Voluntary Critical Illness | Reliance Standard Life Insurance Company | Assured Partners (Central Pa) | 96 | $4,638 20.0% of $23,191 |
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 $106,779
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Independence Administrators | Medical/Rx Fees | $106,779 | $147.28 |