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Employer
1219 Chambersburg Rd, Gettysburg, PA 17325 · EIN 23-2248117 · 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 $25,665
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Dental + Vision | Capital Advantage Assurance Company | Engle, Hambright & Davies, Inc. | 130 | $3,317 6.0% of $55,035 |
| Dental + Vision | Capital Advantage Assurance Company | Assured Partners (Central Pa) | 130 | $1,693 3.1% of $55,035 |
| Life | The Guardian Life Insurance Company Of America | Engle, Hambright & Davies, Inc. | 128 | $10,924 8.1% of $135,691 |
| Life | The Guardian Life Insurance Company Of America | Ap Benefits Advisors | 128 | $6,504 4.8% of $135,691 |
| Life | The Guardian Life Insurance Company Of America | Mazzmar LLC | 128 | $14 0.0% of $135,691 |
| EAP | Wellspan Health | — | — | Schedule A not provided |
| Vol. Life, Vol. Critical Illness, Vol. Accident | Boston Mutual Life Ins. Co. | Benechoice Enrollment Solutions | 18 | $1,928 47.2% of $4,084 |
| Vol. Life, Vol. Critical Illness, Vol. Accident | Boston Mutual Life Ins. Co. | Engle, Hambright & Davies, Inc. | 18 | $1,285 31.5% of $4,084 |
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | — | Comp not disclosed Premium $227 |
| Stop-loss | Avalon Insurance Company | — | 89 | Comp not disclosed Premium $356,583 |
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 $82,130
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group, LLC | Broker | $73,386 | $806.44 |
| Engle-Hambright & Davies, Inc. | Broker | $33,149 | $364.27 |
| Capital Bluecross | Admin | $-24,405 | $-268.19 |