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Employer
3455 East Market Street, York, PA 17402 · EIN 25-1290832 · Oct 1, 2024 to Sep 30, 2025
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 $28,645
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Crum & Forster | — | 191 | Comp not disclosed Premium $362,736 |
| Stop-loss | Optum Health Unimerica Insurance Company | — | 201 | Comp not disclosed Premium $109,227 |
| Dental | Standard Insurance Company | Engle, Hambright & Davies, Inc. | 193 | $9,442 11.7% of $80,522 |
| Vision | Standard Insurance Company | Engle, Hambright & Davies, Inc. | 191 | $873 6.7% of $13,083 |
| Life | Sun Life Assurance Company Of Canada | Engle, Hambright & Davies, Inc. | 362 | $12,480 10.7% of $117,005 |
| Life | Sun Life Assurance Company Of Canada | James R Nelligan & Associates | 362 | $5,850 5.0% of $117,005 |
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 $142,290
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Engle Hambright & Davies, Inc. | Broker | $63,745 | $176.09 |
| The Benecon Group | Broker | $56,197 | $155.24 |
| Highmark Blue Shield (Central) | Admin | $15,400 | $42.54 |
| Upmc Benefit Management Services | Admin | $6,948 | $19.19 |