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Employer
50 Grumbacher Road, Suite 10, York, PA 17406 · EIN 26-3214948 · May 1, 2025 to Jun 30, 2025
Plan year 2025
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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 $2,453
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Avalon Insurance Company | — | 70 | Comp not disclosed Premium $77,611 |
| Dental + Vision | Highmark | Brown & Brown Of Pennsylvania | 160 | $125 1.0% of $11,905 |
| Life | The Lincoln National Life Insurance Company | Brown & Brown Of Pennsylvania | 77 | $197 20.0% of $985 |
| AD&D | The Lincoln National Life Insurance Company | Brown & Brown Of Pennsylvania | 57 | $640 20.0% of $3,198 |
| Other | The Lincoln National Life Insurance Company | Brown & Brown Of Pennsylvania | 77 | $760 20.0% of $3,800 |
| Other | The Lincoln National Life Insurance Company | Brown & Brown Of Pennsylvania | 77 | $731 20.0% of $3,654 |
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 $6,517
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Brown & Brown (Pa) | Broker | $5,040 | $31.50 |
| The Benecon Group | Broker | $3,577 | $22.36 |
| Innovu | Patient Advocate | $560 | $3.50 |
| Capital Bluecross | Admin | $-2,660 | $-16.63 |