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Employer
2901 Montrose Avenue, Laureldale, PA 19605 · EIN 51-0402945 · 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 $20,545
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | — | Comp not disclosed Premium $659 |
| Stop-loss | Crum & Forster | — | 147 | Comp not disclosed Premium $456,330 |
| Dental | Delta Dental | Engle, Hambright & Davies, Inc. | 261 | $2,547 2.9% of $87,105 |
| Dental | Delta Dental | Brown & Brown Of Lehigh Valley | 261 | $1,808 2.1% of $87,105 |
| Vision | Capital Advantage Assurance Company | Engle, Hambright & Davies, Inc. | 224 | $727 5.1% of $14,301 |
| Vision | Capital Advantage Assurance Company | Brown & Brown Insurance Services | 224 | $703 4.9% of $14,301 |
| Vision | Capital Advantage Assurance Company | Brown & Brown Of Lehigh Valley | 224 | $284 2.0% of $14,301 |
| Life | Reliance Standard | Engle, Hambright & Davies, Inc. | 206 | $2,126 4.5% of $47,583 |
| Life | Reliance Standard | Brown & Brown Of Lehigh Valley Inc | 206 | $1,754 3.7% of $47,583 |
| AD&D | Reliance Standard | Engle, Hambright & Davies, Inc. | 150 | $263 8.5% of $3,110 |
| AD&D | Reliance Standard | Brown & Brown Of Lehigh Valley | 150 | $203 6.5% of $3,110 |
| AD&D | Reliance Standard | Engle, Hambright & Davies, Inc. | 206 | $373 8.8% of $4,260 |
| AD&D | Reliance Standard | Brown & Brown Of Lehigh Valley | 206 | $265 6.2% of $4,260 |
| Business Travel | Hartford Life And Accident | — | — | Schedule A not provided |
| Other | Reliance Standard | Engle, Hambright & Davies, Inc. | 124 | $2,350 8.5% of $27,508 |
| Other | Reliance Standard | Brown & Brown Of Lehigh Valley | 124 | $1,727 6.3% of $27,508 |
| Other | Reliance Standard | Engle, Hambright & Davies, Inc. | 206 | $2,857 5.0% of $56,851 |
| Other | Reliance Standard | Brown & Brown Of Lehigh Valley | 206 | $2,348 4.1% of $56,851 |
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 $119,886
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group | Broker | $102,044 | $289.90 |
| Brown & Brown (Pa) | Broker | $50,148 | $142.47 |
| Innovu | Other | $7,160 | $20.34 |
| Capital Advantage Assurance Co | Admin | $-39,466 | $-112.12 |