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Employer
198 Kost Road, Carlisle, PA 17015 · EIN 23-1287636 · Jul 1, 2024 to Jun 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 $73,521
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | 244 | Comp not disclosed Premium $542,306 |
| AD&D | Sun Life Assurance Company Of Canada | Engle, Hambright & Davies, Inc. | 173 | $28,576 15.5% of $184,555 |
| AD&D | Sun Life Assurance Company Of Canada | James R Nelligan & Associates | 173 | $7,949 4.3% of $184,555 |
| Gciee, Grpaccvo, Grphspvoen | Unum Life Insurance Company Of America | Mid-Atlantic Benefit Consultants | 1 | $7 2.5% of $283 |
| Gciee, Grpaccvo, Grphspvoen | Unum Life Insurance Company Of America | Engle, Hambright & Davies, Inc. | 1 | $7 2.5% of $283 |
| Istdprotec, Whole Life | Unum Life Insurance Company Of America | Mid-Atlantic Benefit Consultants | 50 | $629 2.5% of $25,045 |
| Istdprotec, Whole Life | Unum Life Insurance Company Of America | Ehd Advisory Services Inc | 50 | $629 2.5% of $25,045 |
| Istdprotec, Whole Life | Unum Life Insurance Company Of America | Engle, Hambright & Davies, Inc. | 50 | $458 1.8% of $25,045 |
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | — | Comp not disclosed Premium $553 |
| Stop-loss | HM Life Insurance Company | — | 268 | Comp not disclosed Premium $1,257,952 |
| AD&D | Sun Life Assurance Company Of Canada | Engle, Hambright & Davies, Inc. | 164 | $26,145 15.3% of $170,515 |
| AD&D | Sun Life Assurance Company Of Canada | James R Nelligan & Associates | 164 | $9,121 5.3% of $170,515 |
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 $196,798
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Engle Hambright & Davies, Inc. | Broker | $47,752 | $195.70 |
| The Benecon Group | Broker | $23,207 | $95.11 |
| ConnectCare3 | Patient Advocate | $8,061 | $33.04 |
| Capital Bluecross | Admin | $-15,040 | $-61.64 |
| Engle Hambright & Davies, Inc. | Broker | $98,838 | $368.80 |
| The Benecon Group | Broker | $51,040 | $190.45 |
| ConnectCare3 | Patient Advocate | $17,184 | $64.12 |
| Capital Bluecross | Admin | $-34,244 | $-127.78 |