Employer

First Aid And Safety Patrol Of Lebanon

254 South 11th Street, Lebanon, PA 17042 · EIN 23-6299777 · Aug 1, 2023 to Jul 31, 2024

Plan year 2023

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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 $9,465

Coverage	Carrier	Broker	Lives	Direct comp
Stop-loss	HM Life Insurance Company	—	54	Comp not disclosed Premium $318,621
Dental	The Guardian Life Insurance Company Of America	Alpha Benefits Group, Inc	58	$2,433 6.5% of $37,213
Dental	The Guardian Life Insurance Company Of America	Brown & Brown Insurance Services In	58	$1,889 5.1% of $37,213
Vision	National Vision Administrators, LLC	Brown & Brown Of Pennsylvania	151	$268 4.2% of $6,325
Vision	National Vision Administrators, LLC	Brown & Brown Insurance Services, I	151	$49 0.8% of $6,325
Life	Reliance Standard Life Insurance Company	Brown & Brown Of Pennsylvania	75	$533 11.0% of $4,844
Life	Reliance Standard Life Insurance Company	Pacific Resource Benefits Advisors	75	$238 4.9% of $4,844
Other	Reliance Standard Life Insurance Company	Brown & Brown Of Pennsylvania	76	$2,370 15.0% of $15,799
Other	Reliance Standard Life Insurance Company	Pacific Resources Benefits Advisors	76	$772 4.9% of $15,799
Voluntary Group Term Life	Reliance Standard Life Insurance Company	Brown & Brown Of Pennsylvania	5	$685 15.0% of $4,565
Voluntary Group Term Life	Reliance Standard Life Insurance Company	Pacific Resources Benefits Advisors	5	$228 5.0% of $4,565

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 $41,865

Party	Type	Amount	$ / Enrolled / Year
Brown & Brown (Pa)	Broker	$30,030	$198.87
The Benecon Group	Broker	$14,900	$98.68
ConnectCare3	Patient Advocate	$4,204	$27.84
Capital Bluecross	Admin	$-7,269	$-48.14

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