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Employer
950 Smile Way, York, PA 17404 · EIN 23-2149974 · 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 $127,366
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Granular Insurance Company | Marsh & Mclennan Agency, LLC East | 604 | $35,179 4.9% of $724,582 |
| Dental | Delta Dental Of Pennsylvania | Marsh & Mclennan Agency, LLC East | 655 | $13,283 4.2% of $319,657 |
| Vision | Vision Benefits Of America | — | 499 | Comp not disclosed Premium $41,892 |
| Life | Reliance Standard Life Insurance Company | Kelly & Associates Insurance Group | 1301 | $31,059 17.7% of $175,107 |
| Life | Reliance Standard Life Insurance Company | Marsh & Mclennan Agency, LLC East | 1301 | $-2,680 -1.5% of $175,107 |
| Other | Reliance Standard Life Insurance Company | Kelly & Associates Insurance Group | 99 | $6,247 41.2% of $15,159 |
| Other | Reliance Standard Life Insurance Company | Marsh & Mclennan Agency, LLC East | 99 | $-2,444 -16.1% of $15,159 |
| Accidental Death And Dismemberment | Reliance Standard Life Insurance Company | Kelly & Associates Insurance Group | 350 | $2,430 19.1% of $12,731 |
| Accidental Death And Dismemberment | Reliance Standard Life Insurance Company | Marsh & Mclennan Agency, LLC East | 350 | $-393 -3.1% of $12,731 |
| Other | Reliance Standard Life Insurance Company | Kelly & Associates Insurance Group | 817 | $20,447 9.7% of $209,876 |
| Other | Reliance Standard Life Insurance Company | Marsh & Mclennan Agency, LLC East | 817 | $-1,558 -0.7% of $209,876 |
| Other | Reliance Standard Life Insurance Company | Kelly & Associates Insurance Group | 1628 | $28,523 9.8% of $290,316 |
| Other | Reliance Standard Life Insurance Company | Marsh & Mclennan Agency, LLC East | 1628 | $-2,727 -0.9% of $290,316 |
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 $524,919
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Highmark Inc. | Claims Administrator | $361,244 | $221.89 |
| York Building Products Co., Inc. | Plan Administrator | $98,940 | $60.77 |
| Marsh & Mclennan, LLC | Administrator | $54,985 | $33.77 |
| Rkl LLP | Plan Auditor | $9,750 | $5.99 |