Employer
Richard E. Groff & Sons, Inc.
1208 Harrisburg Pike, Lancaster, PA 17603 · EIN 23-2366039 · Dec 1, 2020 to Nov 30, 2021
Plan year 2020
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Schedule A
Direct compensation
Coverage contracts on the filing. If the carrier did not provide Schedule A, the row is listed with that note.
Visible subtotal $803
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Everest Reinsurance Company | — | — | Comp not disclosed Premium $155,733 |
| Dental + Vision | Highmark | Assured Partners (Central Pa) | 56 | $803 11.3% of $7,079 |
Schedule C
Additional compensation
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 $36,880
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Ap Benefit Advisors, LLC | Broker | $21,568 | $385.14 |
| The Benecon Group, LLC | Broker | $17,871 | $319.13 |
| Connectcare 3 | Patient Advocate | $979 | $17.48 |
| Capital Blue Cross | Admin | $-3,538 | $-63.18 |