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Employer
7615 Lancaster Avenue, Myerstown, PA 17067 · EIN 23-2172539 · Jan 1, 2025 to Dec 31, 2025
Plan year 2025
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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 $79,721
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Granular Insurance Company | — | 269 | Comp not disclosed Premium $1,169,695 |
| Dental | United Concordia Insurance Company | Engle, Hambright & Davies, Inc. | 455 | $17,170 10.0% of $171,897 |
| Vision | Vision Benefits Of America | Engle, Hambright & Davies, Inc. | 189 | $3,387 10.0% of $33,702 |
| Vision | Vision Benefits Of America | James R Nelligan & Associates | 189 | $1,668 4.9% of $33,702 |
| Life | Unum Life Insurance Company Of America | Engle, Hambright & Davies, Inc. | 313 | $21,280 12.0% of $177,327 |
| Life | Unum Life Insurance Company Of America | James R Nelligan & Associates | 313 | $15,959 9.0% of $177,327 |
| AD&D | Unum Life Insurance Company Of America | Engle, Hambright & Davies, Inc. | 140 | $13,314 17.3% of $77,139 |
| AD&D | Unum Life Insurance Company Of America | James R Nelligan & Associates | 140 | $6,943 9.0% of $77,139 |
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 $222,706
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Fairbanks, William Matthew | Broker | $61,123 | $134.34 |
| Highmark Inc. | Admin | $161,583 | $355.13 |