Employer
Springfield Restaurant Group, Inc.
1553 Perry Highway, Mercer, PA 16137 · EIN 25-1781312 · Jan 1, 2021 to Dec 31, 2021
Plan year 2021
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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.
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Companion Life Columbia, Sc | — | 75 | Comp not disclosed Premium $109,888 |
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 $90,755
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Enterprise Group Planning, Inc. | Thirdpartyadministrator | $73,874 | $648.02 |
| Davevic Benefit Consultants | Agent | $16,881 | $148.08 |