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Employer
104 Independence Way, Coatesville, PA 19320 · EIN 23-2383776 · 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 $35,696
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optumhealth | — | 124 | Comp not disclosed Premium $346,167 |
| Dental | Delta Dental Of Pennsylvania | Nfp Corporate Services (Pa), Inc. | 180 | $6,710 11.4% of $58,967 |
| Dental | Delta Dental Of Pennsylvania | Johnson, Kendall & Johnson Inc | 180 | $2,135 3.6% of $58,967 |
| Vision | Ameritas Life Insurance Corp | Nfp Corporate Services (Pa), Inc. | 246 | $1,532 12.6% of $12,178 |
| Vision | Ameritas Life Insurance Corp | Johnson, Kendall & Johnson Inc | 246 | $294 2.4% of $12,178 |
| Vision | Ameritas Life Insurance Corp | Nfp Corporate Services (Ny) LLC | 246 | $265 2.2% of $12,178 |
| Life | Standard Insurance Company | Nfp Corporate Services (Pa), Inc. | 166 | $6,503 14.7% of $44,328 |
| Life | Standard Insurance Company | Johnson, Kendall & Johnson Inc | 166 | $1,170 2.6% of $44,328 |
| Other | Standard Insurance Company | Nfp Corporate Services (Pa), Inc. | 166 | $6,654 14.9% of $44,646 |
| Other | Standard Insurance Company | Johnson, Kendall & Johnson Inc | 166 | $1,069 2.4% of $44,646 |
| Other | Standard Insurance Company | Nfp Corporate Services (Pa), Inc. | 166 | $3,975 14.9% of $26,670 |
| Other | Standard Insurance Company | Johnson, Kendall & Johnson Inc | 166 | $689 2.6% of $26,670 |
| Supplemental | Aflac | Main Line Benefit Solutions LLC | 17 | $894 4.4% of $20,170 |
| Supplemental | Aflac | Nfp Corporate Services (Pa), Inc. | 17 | $288 1.4% of $20,170 |
| Supplemental | Aflac | Johnson, Kendall & Johnson Inc | 17 | $283 1.4% of $20,170 |
| Supplemental | Aflac | Steven Ward | 17 | $281 1.4% of $20,170 |
| Supplemental | Aflac | Thomas B Davis | 17 | $213 1.1% of $20,170 |
| Supplemental | Aflac | Bonnie H Drobnes | 17 | $194 1.0% of $20,170 |
| Supplemental | Aflac | Acrisure Wallstreet Partners LLC | 17 | $150 0.7% of $20,170 |
| Supplemental | Aflac | Jayde F Harford | 17 | $106 0.5% of $20,170 |
| Supplemental | Aflac | Nicholas C Bennis | 17 | $101 0.5% of $20,170 |
| Supplemental | Aflac | Nancy Amicon | 17 | $61 0.3% of $20,170 |
| Supplemental | Aflac | Jennifer M Hair | 17 | $32 0.2% of $20,170 |
| Supplemental | Aflac | Arthur B Goldberg | 17 | $30 0.1% of $20,170 |
| Supplemental | Aflac | Susan Hall Tall | 17 | $20 0.1% of $20,170 |
| Supplemental | Aflac | Jeffrey Correal | 17 | $14 0.1% of $20,170 |
| Supplemental | Aflac | Felicia Baker | 17 | $7 0.0% of $20,170 |
| Supplemental | Aflac | Ryan Tavares | 17 | $4 0.0% of $20,170 |
| Supplemental | Aflac | Wendy E Higgins | 17 | $4 0.0% of $20,170 |
| Supplemental | Aflac | Stephanie Ramsey Roth | 17 | $3 0.0% of $20,170 |
| Supplemental | Aflac | Genia Anne Tench | 17 | $3 0.0% of $20,170 |
| Supplemental | Aflac | David S Hallett | 17 | $1 0.0% of $20,170 |
| Other | Standard Insurance Company | Nfp Corporate Services (Pa), Inc. | 29 | $2,011 85.0% of $2,367 |
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 $58,957
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Nfp Corporate Services, Inc. | Broker | $40,150 | $163.21 |
| The Benecon Group | Broker | $26,822 | $109.03 |
| ConnectCare3 | Pt Advocate | $8,688 | $35.32 |
| Highmark Blue Shield (Sepa) | Admin | $179 | $0.73 |
| Highmark Blue Shield (Central) | Admin | $-16,882 | $-68.63 |