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Employer
604 Hemlock Rd, Morgantown, PA 19543 · EIN 87-2135647 · Oct 1, 2024 to Sep 30, 2025
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 $20,665
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 96 | Comp not disclosed Premium $537,374 |
| Dental | Standard Life Insurance Company | James R Nelligan & Associates | 97 | $2,587 6.0% of $43,037 |
| Dental | Standard Life Insurance Company | Engle, Hambright & Davies, Inc. | 97 | $1,636 3.8% of $43,037 |
| Vision | Vision Benefits Of America | Engle, Hambright & Davies, Inc. | 89 | $960 100.0% of $960 |
| Life | Equitable Financial Life Insurance Company Of America | Engle, Hambright & Davies, Inc. | 139 | $11,176 13.9% of $80,588 |
| Life | Equitable Financial Life Insurance Company Of America | Gis Benefits Inc | 139 | $4,306 5.3% of $80,588 |
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 $117,217
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Engle-Hambright & Davies, Inc. | Broker | $40,727 | $424.24 |
| The Benecon Group | Broker | $30,127 | $313.82 |
| Capital Bluecross | Admin. | $-23,740 | $-247.29 |
| Capfinancial Partners LLC | Investment Advisor | $49,360 | $318.45 |
| Fidelity Investments Institutional | Recordkeeper | $20,743 | $133.83 |