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Employer
3940 Locust Lane, Harrisburg, PA 17109 · EIN 23-2428261 · 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 $102,621
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Swissre Corporate Solutions | — | 864 | Comp not disclosed Premium $1,463,333 |
| Life | United Of Omaha Life Insurance Company | Engle, Hambright & Davies, Inc. | 971 | $1,798 10.0% of $17,984 |
| Life | United Of Omaha Life Insurance Company | James R Nelligan & Associates | 971 | $317 1.8% of $17,984 |
| AD&D | United Of Omaha Life Insurance Company | Engle, Hambright & Davies, Inc. | 495 | $16,614 12.0% of $138,447 |
| AD&D | United Of Omaha Life Insurance Company | James R Nelligan & Associates | 495 | $2,109 1.5% of $138,447 |
| Voluntary Short Term Disability | United Of Omaha Life Insurance Company | Engle, Hambright & Davies, Inc. | 369 | $40,924 8.0% of $511,548 |
| Voluntary Short Term Disability | United Of Omaha Life Insurance Company | James R Nelligan & Associates | 369 | $8,662 1.7% of $511,548 |
| Voluntary Long Term Disability | United Of Omaha Life Insurance Company | Engle, Hambright & Davies, Inc. | 295 | $27,818 10.0% of $278,179 |
| Voluntary Long Term Disability | United Of Omaha Life Insurance Company | James R Nelligan & Associates | 295 | $4,379 1.6% of $278,179 |
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 $545,638
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Meritain Health | Admin | $497,643 | $495.66 |
| United Concordia Companies, Inc. | Admin | $28,999 | $28.88 |
| Highmark Inc. | Admin | $18,996 | $18.92 |