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Employer
P.O. Box 1773, Carlisle, PA 17013 · EIN 23-1365954 · Jan 1, 2024 to Dec 31, 2024
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 $36,370
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Ace American Insurance Company | Rcm&D | 660 | $7,129 15.2% of $46,751 |
| Vision | Vision Benefits Of America | — | 622 | Comp not disclosed Premium $72,292 |
| Life | Reliance Standard Life Insurance Company | Relph Benefit Advisors | 777 | $9,883 5.0% of $197,667 |
| Life | Reliance Standard Life Insurance Company | American Insurance Administrators | 777 | $4,836 2.4% of $197,667 |
| AD&D | Ace American Insurance Company | — | 608 | Comp not disclosed |
| AD&D | Reliance Standard Life Insurance Company | Relph Benefit Advisors | 777 | $987 5.0% of $19,734 |
| AD&D | Reliance Standard Life Insurance Company | American Insurance Administrators | 777 | $475 2.4% of $19,734 |
| AD&D | Reliance Standard Life Insurance Company | Relph Benefit Advisors | 22 | $36 5.0% of $723 |
| AD&D | Reliance Standard Life Insurance Company | American Insurance Administrators | 22 | $20 2.8% of $723 |
| AD&D | Hartford Life And Accident | Tri County Agency Inc | 777 | $4,587 21.0% of $21,813 |
| Other | Continental American Insurance Company | J D Luedtke, Inc. | 14 | $280 3.7% of $7,547 |
| Other | Continental American Insurance Company | C H Robinson & Associates, Inc. | 14 | $274 3.6% of $7,547 |
| Other | Continental American Insurance Company | Anthony S Almodovar | 14 | $112 1.5% of $7,547 |
| Other | Continental American Insurance Company | Robert G Relph Agency, Inc. | 14 | $64 0.8% of $7,547 |
| Other | Continental American Insurance Company | Mg Berger, Inc. | 14 | $37 0.5% of $7,547 |
| Other | Continental American Insurance Company | Ryan K Goldberg | 14 | $7 0.1% of $7,547 |
| Other | Continental American Insurance Company | Darren D Riddle | 14 | $6 0.1% of $7,547 |
| Other | Continental American Insurance Company | Martin E Bystrom | 14 | $6 0.1% of $7,547 |
| Other | Continental American Insurance Company | Angela Massarelli | 14 | $4 0.1% of $7,547 |
| Other | Continental American Insurance Company | Angela Umosella | 14 | $2 0.0% of $7,547 |
| Other | Reliance Standard Life Insurance Company | Relph Benefit Advisors | 777 | $5,170 5.0% of $103,391 |
| Other | Reliance Standard Life Insurance Company | American Insurance Administrators | 777 | $2,455 2.4% of $103,391 |
| Medical | Aetna Life Insurance Company | — | — | Comp not disclosed Premium $53,241 |
| Dental | Aetna Life Insurance Company | — | — | Comp not disclosed Premium $7,715 |
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 $61,724
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Emeriti Retirement Health Solutions | None | $53,963 | $49.83 |
| Tiaa | None | $7,761 | $7.17 |