# PELLA MID-ATLANTIC EMPLOYEE BENEFIT PLAN

Health and welfare plan sponsored by **PELLA MID-ATLANTIC INC.**. Form 5500 filing for plan year 2025.

| Field | Value |
|---|---|
| Sponsor | PELLA MID-ATLANTIC INC. |
| EIN | 831224745 |
| Plan number | 501 |
| Plan year | 2025 |
| Location | BELTSVILLE, MD |
| Industry | building materials |
| Funding | mixed |
| Total premiums | $135K |
| Participants | 173 |
| Persons covered | 173 |

## Insurance carriers (Schedule A)

| Carrier | Coverage |
|---|---|
| HARTFORD LIFE AND ACCIDENT | Life, LTD, Other |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY | Dental, Indemnity |
| FIDELITY SECURITY LIFE INSURANCE COMPANY | Vision |
| UNITED LEGAL BENEFITS | Other |

## Brokers

| Broker | Placed with |
|---|---|
| KELLY & ASSOCIATES INSURANCE GROUP | HARTFORD LIFE AND ACCIDENT |
| HILB GROUP OF NEW ENGLAND | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES |
| KELLY & ASSOCIATES INSURANCE GROUP | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES |
| HILB GROUP OF NEW ENGLAND | FIDELITY SECURITY LIFE INSURANCE COMPANY |
| KELLY & ASSOCIATES INSURANCE GROUP | FIDELITY SECURITY LIFE INSURANCE COMPANY |

## About this data

- Source: public Form 5500 filings from the U.S. Department of Labor (EBSA), rebuilt on each DOL release.
- Full page (charts, history, peer benchmarks, fees, contacts): https://planoptica.com/welfare/831224745-501
- Cite as: PlanOptica, https://planoptica.com/welfare/831224745-501
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