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Employer
1969 Clearview Road, Souderton, PA 18964 · EIN 23-2363698 · Jan 1, 2025 to Dec 31, 2025
Plan year 2025
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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 $262,958
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Independence Blue Cross (Ppo & Drug) | Emerson Rogers LLC | 234 | $75,212 3.9% of $1,916,698 |
| Medical | Highmark (Med And Drug) | Fourm Consulting, Inc. | 413 | $48,862 1.9% of $2,525,697 |
| Medical | Independence Blue Cross (Keystone) | Emerson Rogers LLC | 108 | $30,150 4.1% of $737,479 |
| Dental | Aetna Life Insurance Co (Dental) | Fourm Consulting, Inc. | 350 | $6,137 4.3% of $142,983 |
| Dental | United Concordia Insurance Company (Dental) | Fourm Consulting, Inc. | 412 | $13,924 10.6% of $131,538 |
| Vision | Highmark (Vision) | Fourm Consulting, Inc. | 400 | Comp not disclosed Premium $19,644 |
| Vision | Independence Blue Cross (Vision) | Emerson Rogers LLC | 340 | $4,225 21.6% of $19,526 |
| Life | United Of Omaha Life Insurance Company (Life/Ad&D) | Emerson Rogers LLC | 349 | $26,603 15.4% of $172,979 |
| Life | Chubb-Federal Insurance Company (Ad&D) | — | — | Schedule A not provided |
| Other | United Of Omaha Life Insurance Company (Ltdi) | Emerson Rogers LLC | 349 | $16,083 17.4% of $92,466 |
| Other | United Of Omaha Life Insurance Company (Stdi) | Emerson Rogers LLC | 349 | $39,726 21.9% of $181,322 |
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.
No Schedule C parties in this year.