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Employer
P.O. Box 39, Carlisle, PA 17013 · EIN 23-1530123 · Jun 1, 2024 to May 31, 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 $39,261
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Hcc Life Insurance Company | Benefit Connections, Inc. | 120 | $21,868 15.0% of $145,785 |
| Vision | National Vision Administrators, LLC (Heartland) | Benefit Connections, Inc. | 164 | $605 4.8% of $12,702 |
| Life | Prudential | Benefit Connections, Inc. | 104 | $12,729 15.0% of $84,862 |
| Life | Prudential | Img | 104 | $23 0.0% of $84,862 |
| Life | Unum Life Insurance Company Of America | Benefit Connections, Inc. | 56 | $2,658 15.0% of $17,721 |
| AD&D | Federal Insurance Company | — | — | Schedule A not provided |
| AD&D | Unum Life Insurance Company Of America | Benefit Connections, Inc. | 12 | $623 15.0% of $4,151 |
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 $46,223
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Highmark, Inc. | Admin | $19,507 | $74.17 |
| Boyer & Ritter LLC | Audit | $14,500 | $55.13 |
| United Concordia Companies, Inc. | Admin | $11,425 | $43.44 |
| Compsych | Admin | $791 | $4.82 |