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Employer
151 Koser Road, Lititz, PA 17543 · EIN 86-1520738 · Jul 1, 2024 to Jun 30, 2025
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 $8,500
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 55 | Comp not disclosed Premium $28,160 |
| Dental | Unitedhealthcare Insurance Company | — | — | Schedule A not provided |
| Vision | Capital Advantage Assurance Company | Engle, Hambright & Davies, Inc. | 78 | $30 4.0% of $756 |
| Life | Sun Life Assurance Company Of Canada | Engle, Hambright & Davies, Inc. | 55 | $2,833 12.1% of $23,450 |
| Life | Sun Life Assurance Company Of Canada | James R Nelligan & Associates | 55 | $1,190 5.1% of $23,450 |
| Stop-loss | HM Life Insurance Company | — | 51 | Comp not disclosed Premium $192,661 |
| Dental | Unitedhealthcare Insurance Company | Engle, Hambright & Davies, Inc. | 55 | $1,601 7.4% of $21,590 |
| Dental | Unitedhealthcare Insurance Company | Mcconkey Benefits & Financial Servi | 55 | $558 2.6% of $21,590 |
| Dental | Unitedhealthcare Insurance Company | James R Nelligan & Associates | 55 | $93 0.4% of $21,590 |
| Vision | Capital Advantage Assurance Company | Mcconkey Benefits & Financial Servi | 80 | $233 4.0% of $5,819 |
| Life | Sun Life Assurance Company Of Canada | Engle, Hambright & Davies, Inc. | 54 | $1,444 13.9% of $10,369 |
| Life | Sun Life Assurance Company Of Canada | James R Nelligan & Associates | 54 | $518 5.0% of $10,369 |
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 $50,528
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Engle-Hambright & Davies | Broker | $2,641 | $33.86 |
| The Benecon Group | Broker | $1,889 | $24.22 |
| Capital Bluecross | Admin | $1,212 | $15.54 |
| ConnectCare3 | Patient Advocate | $415 | $5.32 |
| Engle-Hambright & Davies | Broker | $20,132 | $251.65 |
| The Benecon Group | Broker | $18,408 | $230.10 |
| Capital Bluecross | Admin | $5,831 | $72.89 |