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Employer
2589 Interstate Drive, Harrisburg, PA 17110 · EIN 23-2029140 · May 1, 2021 to Apr 30, 2022
Plan year 2021
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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 $29,917
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Life | Life Insurance Company Of North America | Ingroup Associates, Inc. | 530 | $8,808 18.8% of $46,966 |
| Life | Life Insurance Company Of North America | Benefitmall | 530 | $1,756 3.7% of $46,966 |
| Accidental Death | Life Insurance Company Of North America | Ingroup Associates, Inc. | 530 | $1,215 18.8% of $6,478 |
| Accidental Death | Life Insurance Company Of North America | Benefitmall | 530 | $405 6.3% of $6,478 |
| Other | Hartford Life And Accident | Ingroup Associates, Inc. | 835 | $17,733 12.0% of $147,629 |
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 $375,980
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Xpyria Investment Advisors Inc | N/A | $89,309 | $79.67 |
| Linda Whittington | Employee | $70,311 | $62.72 |
| Delta Dental | N/A | $64,581 | $57.61 |
| Joanna Chronister | Employee | $54,897 | $48.97 |
| Express Scripts | Admin | $30,932 | $27.59 |
| Brown Schultz Sheridan & Fritz | N/A | $25,500 | $22.75 |
| Willig Williams & Davidson | N/A | $17,023 | $15.19 |
| The Savitz Organization | N/A | $11,700 | $10.44 |
| 90 Degree Benefits | N/A | $6,000 | $5.35 |
| National Vision Adminstrators | N/A | $5,727 | $5.11 |