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Employer
351 Northgate Circle, Suite B, New Castle, PA 16105 · EIN 25-1002501 · 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 $140,861
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | Fourm Consulting, Inc. | 2272 | $136,277 6.1% of $2,244,387 |
| Dental | United Concordia Insurance Company | — | 1590 | Comp not disclosed Premium $396,671 |
| Life | Dearborn National Life Insurance Company | Fourm Consulting, Inc. | 624 | $4,584 6.9% of $66,754 |
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 $286,678
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Fourm Consulting, Inc. | None | $81,420 | $35.59 |
| Xpyria Investment Advisors Inc. | None | $63,726 | $27.85 |
| Bridgeway Benefits Technology | None | $55,341 | $24.19 |
| Jubelirer, Pass & Interieri | None | $22,400 | $9.79 |
| Cerity Partners LLC | None | $21,455 | $9.38 |
| Henry Rossi & Co., LLP | None | $15,500 | $6.77 |
| Albanese Sinchar Smith & Co. | None | $12,000 | $5.24 |
| Phoenix Benefits Group, Inc. | None | $7,550 | $3.30 |
| Nellcom Technologies | None | $7,286 | $3.18 |