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Employer
815 South Street, Pottstown, PA 19464 · EIN 23-2648377 · 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 $21,079
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | — | Comp not disclosed Premium $514 |
| Stop-loss | Sun Life Assurance Company | — | 112 | Comp not disclosed Premium $445,165 |
| Dental | Delta Dental Of Pennsylvania | Rsc Ins Brokerage Inc | 133 | $1,762 |
| Dental | Delta Dental Of Pennsylvania | Fairmount Benefits, Inc. | 133 | $938 |
| Vision | Independence Blue Cross | — | — | Schedule A not provided |
| Life | United Of Omaha Life Insurance Company | Farimount Benefits Inc. | 27 | $4,105 18.0% of $22,809 |
| Life | United Of Omaha Life Insurance Company | Farimount Benefits Inc. | 27 | $796 3.5% of $22,809 |
| Other | United Of Omaha Life Insurance Company | Fairmount Benefits, Inc. | 127 | $5,304 13.6% of $38,864 |
| Other | United Of Omaha Life Insurance Company | Fairmount Benefits, Inc. | 127 | $1,166 3.0% of $38,864 |
| Other | United Of Omaha Life Insurance Company | Farimount Benefits Inc. | 127 | $5,454 13.0% of $41,954 |
| Other | United Of Omaha Life Insurance Company | Farimount Benefits Inc. | 127 | $1,554 3.7% of $41,954 |
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 $94,361
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Fairmount Benefits Inc. | Broker | $56,406 | $466.17 |
| The Benecon Group, LLC | Broker | $21,341 | $176.37 |
| Independence Administrators (Ia) | Admin | $9,200 | $76.03 |
| ConnectCare3 | Patient Advocate | $7,414 | $61.27 |