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Employer
800 West Church Road, Mechanicsburg, PA 17055 · EIN 23-1885979 · Mar 1, 2024 to Apr 30, 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 $201,322
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Highmark Inc. | — | 783 | Comp not disclosed Premium $5,514,216 |
| Dental | United Concordia Insurance Company | American Insurance Administrators | 812 | $1 0.0% of $235,459 |
| Life | United Of Omaha Life Insurance Company | Mcgriff Insurance Services Inc. | 570 | $12,174 15.5% of $78,432 |
| Life | United Of Omaha Life Insurance Company | National Enrollment Partners, LLC | 570 | $3,922 5.0% of $78,432 |
| Life | United Of Omaha Life Insurance Company | Benechoice | 570 | $1,961 2.5% of $78,432 |
| Life | Aflac | David R Ponta | 298 | $487 0.1% of $355,617 |
| Life | Aflac | Earmon Allen Johnson | 298 | $444 0.1% of $355,617 |
| Life | Aflac | Heidi Cook | 298 | $376 0.1% of $355,617 |
| Life | Aflac | Jennifer Lynn Turner | 298 | $282 0.1% of $355,617 |
| Life | Aflac | Michelle L Mannix | 298 | $258 0.1% of $355,617 |
| Life | Aflac | Andrea Lynn Bennett | 298 | $221 0.1% of $355,617 |
| Life | Aflac | Daniel N Mara | 298 | $176 0.0% of $355,617 |
| Life | Aflac | Tatiana Victoria Leitzel | 298 | $166 0.0% of $355,617 |
| Life | Aflac | William L Murray Jr | 298 | $68 0.0% of $355,617 |
| Life | Aflac | Michelle K Kelly | 298 | $62 0.0% of $355,617 |
| Life | Aflac | Michael S Dysart | 298 | $44 0.0% of $355,617 |
| Life | Aflac | Douglas R Borland | 298 | $33 0.0% of $355,617 |
| Life | Aflac | J D Luedtke Inc | 298 | $17,641 5.0% of $355,617 |
| Life | Aflac | American Ins Adm Inc | 298 | $12,690 3.6% of $355,617 |
| Life | Aflac | Benechoice Enrollment Solutions & T | 298 | $12,689 3.6% of $355,617 |
| Life | Aflac | Mcgriff Insurance Services Inc. | 298 | $7,038 2.0% of $355,617 |
| Life | Aflac | Anthony S Almodovar | 298 | $3,208 0.9% of $355,617 |
| Life | Aflac | Focus Hro LLC | 298 | $3,145 0.9% of $355,617 |
| Life | Aflac | Liam Cassidy | 298 | $1,678 0.5% of $355,617 |
| Life | Aflac | Maryssa Figlioli | 298 | $1,054 0.3% of $355,617 |
| Life | Aflac | Tammy Meyers | 298 | $959 0.3% of $355,617 |
| Life | Aflac | Julian A Sitts | 298 | $663 0.2% of $355,617 |
| Life | Aflac | Dianne L Martin | 298 | $649 0.2% of $355,617 |
| Other | United Of Omaha Life Insurance Company | Mcgriff Insurance Services Inc. | 27 | $1,020 15.1% of $6,762 |
| Other | United Of Omaha Life Insurance Company | National Enrollment Partners, LLC | 27 | $338 5.0% of $6,762 |
| Other | United Of Omaha Life Insurance Company | Benechoice | 27 | $169 2.5% of $6,762 |
| Other | United Of Omaha Life Insurance Company | Mcgriff Insurance Services Inc. | 602 | $38,299 15.7% of $244,520 |
| Other | United Of Omaha Life Insurance Company | National Enrollment Partners, LLC | 602 | $12,226 5.0% of $244,520 |
| Other | United Of Omaha Life Insurance Company | Benechoice | 602 | $6,113 2.5% of $244,520 |
| Other | United Of Omaha Life Insurance Company | Mcgriff Insurance Services Inc. | 77 | $12,736 21.2% of $59,939 |
| Other | United Of Omaha Life Insurance Company | National Enrollment Partners, LLC | 77 | $2,997 5.0% of $59,939 |
| Other | United Of Omaha Life Insurance Company | Benechoice | 77 | $1,498 2.5% of $59,939 |
| Life | Wilco Life Insurance Company | — | 4 | Schedule A not provided |
| Other | Standard Insurance Company | — | 750 | Comp not disclosed |
| Medical | Highmark Inc. | American Insurance Administrators | 832 | $13,000 1.4% of $953,580 |
| Dental | United Concordia Insurance Company | American Insurance Administrators | 854 | $2 0.0% of $37,643 |
| Life | United Of Omaha Life Insurance Company | Mcgriff Insurance Services Inc. | 610 | $4,648 35.7% of $13,037 |
| Life | Aflac | American Ins Adm Inc | 341 | $2,111 4.3% of $49,226 |
| Life | Aflac | J D Luedtke Inc | 341 | $1,433 2.9% of $49,226 |
| Life | Aflac | Focus Hro LLC | 341 | $522 1.1% of $49,226 |
| Life | Aflac | Anthony S Almodovar | 341 | $431 0.9% of $49,226 |
| Life | Aflac | Tammy Meyers | 341 | $159 0.3% of $49,226 |
| Life | Aflac | Dianne L Martin | 341 | $120 0.2% of $49,226 |
| Life | Aflac | David R Ponta | 341 | $94 0.2% of $49,226 |
| Life | Aflac | Earmon Allen Johnson | 341 | $71 0.1% of $49,226 |
| Life | Aflac | Heidi Cook | 341 | $56 0.1% of $49,226 |
| Life | Aflac | Andrea Lynn Bennett | 341 | $31 0.1% of $49,226 |
| Life | Aflac | Daniel N Mara | 341 | $28 0.1% of $49,226 |
| Life | Aflac | Michelle L Mannix | 341 | $20 0.0% of $49,226 |
| Life | Aflac | William L Murray Jr | 341 | $11 0.0% of $49,226 |
| Life | Aflac | Michelle K Kelly | 341 | $6 0.0% of $49,226 |
| Other | United Of Omaha Life Insurance Company | Mcgriff Insurance Services Inc. | 32 | $277 35.9% of $771 |
| Other | United Of Omaha Life Insurance Company | Mcgriff Insurance Services Inc. | 641 | $14,211 33.7% of $42,108 |
| Other | United Of Omaha Life Insurance Company | Mcgriff Insurance Services Inc. | 67 | $6,606 42.6% of $15,522 |
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 $81,502
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Stancorp Financial Group | None | $81,502 | $105.03 |
| Reliance Trust Company | None | Comp not disclosed | — |