Employer
Keystone Custom Management, LLC
227 Granite Run, Lancaster, PA 17601 · EIN 82-3599092 · Jan 1, 2024 to Dec 31, 2024
Plan year 2024
Covered lives: 224
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 $15,156
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance | — | 99 | Comp not disclosed Premium $416,077 |
| Dental + Vision | Highmark Inc. | Alera Group, Inc | 224 | $3,597 5.5% of $64,995 |
| Dental + Vision | Highmark Inc. | Cagliola, David | 224 | $2,315 3.6% of $64,995 |
| Life | Principal Life Insurance Company | Simkiss & Block, An Alera Group Age | 80 | $9,244 14.5% of $63,585 |
Schedule C
Additional compensation
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 $38,491
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Simkiss&Block,An Alera Group Agecy | Broker | $36,930 | $164.87 |
| The Benecon Group | Broker | $20,355 | $90.87 |
| ConnectCare3 | Patient Advocate | $6,721 | $30.00 |
| Capital Bluecross | Admin | $-25,515 | $-113.91 |