Employer
Smilebuilderz, LLC.
204 Butler Ave, Lancaster, PA 17601 · EIN 20-3167069 · Jul 1, 2024 to Jun 30, 2025
Plan year 2024
Covered lives: 211
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 $20,575
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 12 | Comp not disclosed Premium $306,573 |
| Medical | Principal Life Insurance Company | Ap Benefit Advisors, LLC | 211 | $6,295 12.4% of $50,689 |
| Medical | Principal Life Insurance Company | Gis Benefits Inc | 211 | $3,187 6.3% of $50,689 |
| Other | Lincoln National Life Insurance Company | Ap Benefit Advisors, LLC | 24 | $2,947 14.9% of $19,780 |
| Other | Lincoln National Life Insurance Company | Gis Benefits Inc | 24 | $989 5.0% of $19,780 |
| Other | Lincoln National Life Insurance Company | Ap Benefit Advisors LLC (Attn Lynn) | 24 | $687 3.5% of $19,780 |
| Other | Lincoln National Life Insurance Company | Ap Benefit Advisors, LLC | 53 | $4,109 14.8% of $27,762 |
| Other | Lincoln National Life Insurance Company | Gis Benefits Inc | 53 | $1,388 5.0% of $27,762 |
| Other | Lincoln National Life Insurance Company | Ap Benefit Advisors LLC (Attn Lynn) | 53 | $973 3.5% of $27,762 |
| Telemedicine | Teladoc | — | — | Schedule A not provided |
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 $66,818
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group, LLC | Broker | $51,998 | $499.98 |
| Assured Partners (Central Pa) | Broker | $42,834 | $411.87 |
| Highmark Blue Shield (Central) | Admin | $-1,874 | $-18.02 |
| Capital Bluecross | Admin. | $-26,140 | $-251.35 |