Employer
Boose At Cornwall, Inc.
402 Schaeffer Road, Lebanon, PA 17042 · EIN 20-5061064 · Jan 1, 2024 to Dec 31, 2024
Plan year 2024
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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.
Visible subtotal $389
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Everest Reinsurance Company | — | — | Comp not disclosed Premium $244 |
| Stop-loss | HM Life Insurance Company | — | 32 | Comp not disclosed Premium $155,803 |
| Life | Unum Life Insurance Company Of America | Engle, Hambright & Davies, Inc. | 45 | $389 9.9% of $3,945 |
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 $41,413
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Engle Hambright & Davies, Inc. | Broker | $12,605 | $280.11 |
| The Benecon Group, LLC | Broker | $8,919 | $198.20 |
| Highmark Blue Shield (Central) | Admin | $13,668 | $303.73 |
| Mca Administrators | Admin | $3,707 | $82.38 |
| Connectcare 3 | Patient Advocate | $2,514 | $55.87 |