Employer
Signature Custom Cabinetry, Inc.
434 Springville Road, Ephrata, PA 17522 · EIN 23-2644244 · Jan 1, 2025 to Dec 31, 2025
Plan year 2025
Covered lives: 208
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 $3,268
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Crum & Forster | — | 102 | Comp not disclosed Premium $623,317 |
| Vision | Highmark, Inc. | Dombach, Tara | 208 | $601 4.0% of $15,016 |
| Life | Reliance Standard Life Insurance Company | Engle, Hambright & Davies | 119 | $1,731 9.2% of $18,720 |
| Life | Reliance Standard Life Insurance Company | James R Nelligan & Associates LLC | 119 | $936 5.0% of $18,720 |
| Voluntary Basic Life, Dependent Life | Reliance Standard | — | — | Schedule A not provided |
| EAP | Quest Behavioral Health | — | — | Schedule A not provided |
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 $58,318
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Engle-Hambright & Davies, Inc. | Broker | $43,365 | $394.23 |
| The Benecon Group, LLC | Broker | $26,225 | $238.41 |
| Capital Bluecross | Admin | $-16 | $-0.15 |
| Highmark Blue Shield (Central) | Admin | $-13,095 | $-119.05 |
| Reliance Standard Life Insurance Co | Admin | $1,839 | $8.84 |