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Employer
400 S. Salem Church Rd, York, PA 17408 · EIN 45-0701546 · 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 $49,883
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Dental | The Lincoln National Life Insurance Comapny | Assured Partners (Central Pa) | 109 | $6,595 10.0% of $65,948 |
| Dental | The Lincoln National Life Insurance Comapny | Gis Benefits Inc | 109 | $3,824 5.8% of $65,948 |
| Dental | The Lincoln National Life Insurance Comapny | Assured Partners (Central Pa) | 109 | $1,755 2.7% of $65,948 |
| Dental + Vision | Metropolitan Life Insurance Company | Assured Partners (Central Pa) | — | $997 619.3% of $161 |
| Dental + Vision | Metropolitan Life Insurance Company | Assured Partners (Central Pa) | — | $183 113.7% of $161 |
| Life | The Lincoln National Life Insurance Company | Assured Partners (Central Pa) | 166 | $3,969 15.0% of $26,458 |
| Life | The Lincoln National Life Insurance Company | Gis Benefits Inc | 166 | $1,716 6.5% of $26,458 |
| Life | The Lincoln National Life Insurance Company | Assured Partners (Central Pa) | 166 | $1,309 4.9% of $26,458 |
| AD&D | The Lincoln National Life Insurance Company | Assured Partners (Central Pa) | 46 | $269 15.0% of $1,796 |
| AD&D | The Lincoln National Life Insurance Company | Gis Benefit Inc | 46 | $123 6.8% of $1,796 |
| AD&D | The Lincoln National Life Insurance Company | Assured Partners (Central Pa) | 46 | $111 6.2% of $1,796 |
| Other | The Lincoln National Life Insurance Company | Assured Partners (Central Pa) | 166 | $5,662 15.0% of $37,747 |
| Other | The Lincoln National Life Insurance Company | Gis Benefits Inc | 166 | $2,450 6.5% of $37,747 |
| Other | The Lincoln National Life Insurance Company | Assured Partners (Central Pa) | 166 | $1,877 5.0% of $37,747 |
| Vol. Vision | The Lincoln National Life Insurance Company | Assured Partners (Central Pa) | 99 | $679 5.0% of $13,582 |
| Vol. Vision | The Lincoln National Life Insurance Company | Gis Benefits Inc | 99 | $789 5.8% of $13,582 |
| Vol. Vision | The Lincoln National Life Insurance Company | Assured Partners (Central Pa) | 99 | $366 2.7% of $13,582 |
| Vol Childs Life, Vol. Spouse Life, Vol. Life | The Lincoln National Life Insurance Company | Assured Partners (Central Pa) | 58 | $4,294 15.0% of $28,628 |
| Vol Childs Life, Vol. Spouse Life, Vol. Life | The Lincoln National Life Insurance Company | Gis Benefits Inc | 58 | $1,921 6.7% of $28,628 |
| Vol Childs Life, Vol. Spouse Life, Vol. Life | The Lincoln National Life Insurance Company | Assured Partners (Central Pa) | 58 | $1,631 5.7% of $28,628 |
| Weekly Income | The Lincoln National Life Insurance Company | Assured Partners (Central Pa) | 166 | $5,298 15.0% of $35,321 |
| Weekly Income | The Lincoln National Life Insurance Company | Gis Benefits Inc | 166 | $2,297 6.5% of $35,321 |
| Weekly Income | The Lincoln National Life Insurance Company | Assured Partners (Central Pa) | 166 | $1,768 5.0% of $35,321 |
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 $7,897
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Capital Advantage Assurance Company | Broker | $7,897 | $22.96 |