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Employer
3399 Trindle Road, Camp Hill, PA 17011 · EIN 23-1875547 · Jan 1, 2024 to Dec 31, 2024
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 $84,906
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Hcc Life Insurance Company | — | 260 | Schedule A not provided |
| Dental | Delta Dental Of Pennsylvania | Hilb Group Of Maryland | 494 | $10,109 7.3% of $138,071 |
| Dental | Delta Dental Of Pennsylvania | Gallagher Fiduciary Advisors, LLC | 494 | $3,699 2.7% of $138,071 |
| Vision | Vision Service Plan | — | 228 | Comp not disclosed Premium $31,307 |
| Life | United Of Omaha Life Insurance Company | Hilb Group Of Maryland | 314 | $4,495 18.9% of $23,793 |
| Life | United Of Omaha Life Insurance Company | Gallgher Benefit Services Inc | 314 | $1,217 5.1% of $23,793 |
| Life | United Of Omaha Life Insurance Company | Gallgher Benefit Services Inc | 314 | $563 2.4% of $23,793 |
| Voluntary Life And Accidental Death & Dismemberment | United Of Omaha Life Insurance Company | Hilb Group Of Maryland | 113 | $3,190 15.3% of $20,824 |
| Voluntary Life And Accidental Death & Dismemberment | United Of Omaha Life Insurance Company | Gallgher Benefit Services Inc | 113 | $754 3.6% of $20,824 |
| Voluntary Life And Accidental Death & Dismemberment | United Of Omaha Life Insurance Company | Gallgher Benefit Services Inc | 113 | $460 2.2% of $20,824 |
| Critical Illness | Metropolitan Life Insurance Company | Hilb Group Of Maryland | 80 | $3,365 19.8% of $17,015 |
| Critical Illness | Metropolitan Life Insurance Company | Plansource Benefits Administration | 80 | $567 3.3% of $17,015 |
| Critical Illness | Metropolitan Life Insurance Company | Gallgher Benefit Services Inc | 80 | $497 2.9% of $17,015 |
| Accident | Metropolitan Life Insurance Company | Hilb Group Of Maryland | 134 | $2,448 18.1% of $13,493 |
| Accident | Metropolitan Life Insurance Company | Plansource Benefits Administration | 134 | $426 3.2% of $13,493 |
| Accident | Metropolitan Life Insurance Company | Gallagher Fiduciary Advisors, LLC | 134 | $338 2.5% of $13,493 |
| Accident | Metropolitan Life Insurance Company | Psa Insurance & Financial Partners | 134 | $139 1.0% of $13,493 |
| Other | United Of Omaha Life Insurance Company | Hilb Group Of Maryland | 328 | $37,093 18.5% of $200,141 |
| Other | United Of Omaha Life Insurance Company | Gallagher Fiduciary Advisors, LLC | 328 | $10,259 5.1% of $200,141 |
| Other | United Of Omaha Life Insurance Company | Gallgher Benefit Serrvices Inc | 328 | $4,655 2.3% of $200,141 |
| Other | United Of Omaha Life Insurance Company | Hilb Group Of Maryland | 313 | $361 |
| Other | United Of Omaha Life Insurance Company | Gallgher Benefit Services Inc | 313 | $271 |
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 $126,905
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Grief, Jonathan B | Broker | Comp not disclosed | — |
| Alera Group, Inc. | Broker | Comp not disclosed | — |
| Highmark Inc. | Admin | $126,905 | $256.89 |