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Employer
221 West Philadelphia St, York, PA 17401 · EIN 23-2849147 · Jan 1, 2022 to Dec 31, 2022
Plan year 2022
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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 $66,129
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 40 | Comp not disclosed Premium $201,155 |
| Medical | United Healthcare Insurance Co | Richards, Inc. | 193 | $56,761 3.7% of $1,539,219 |
| Life | Northwestern Mutual | R Todd Grandy | 75 | $721 7.9% of $9,123 |
| Life | Northwestern Mutual | Scott Iodice Assc LLC | 75 | $174 1.9% of $9,123 |
| Life | Northwestern Mutual | David Wayne Ziegler | 75 | $64 0.7% of $9,123 |
| Other | Northwestern Mutual | Jason S Bell | 59 | $2,922 5.5% of $53,348 |
| Other | Northwestern Mutual | R Todd Grandy | 59 | $2,892 5.4% of $53,348 |
| Other | Northwestern Mutual | Scott Iodice Assc LLC | 59 | $795 1.5% of $53,348 |
| Other | Northwestern Mutual | David Wayne Ziegler | 59 | $303 0.6% of $53,348 |
| Other | Northwestern Mutual | R Todd Grandy | 45 | $636 7.1% of $9,005 |
| Other | Northwestern Mutual | Jason S Bell Ste 310 | 45 | $626 7.0% of $9,005 |
| Other | Northwestern Mutual | Scott Iodice Assc LLC | 45 | $172 1.9% of $9,005 |
| Other | Northwestern Mutual | David Wayne Ziegler | 45 | $63 0.7% of $9,005 |
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 $38,711
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Engle Hambright & Davies, Inc. | Broker | $16,298 | $84.45 |
| The Benecon Group | Broker | $10,932 | $56.64 |
| Highmark | Admin | $7,991 | $41.40 |
| Connectcare 3 | Patient Advocate | $2,392 | $12.39 |
| Wellspan | Admin | $1,098 | $5.69 |