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Employer
1021 Springboard Drive, Hershey, PA 17033 · EIN 80-0113235 · 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 $23,802
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 254 | Comp not disclosed Premium $1,027,836 |
| Dental | Delta Dental Of Pennsylvania | Engle, Hambright & Davies, Inc. | 398 | $5,294 5.0% of $105,884 |
| Vision | Highmark, Inc. | Fairbanks, William Matthew | 360 | $739 3.0% of $24,822 |
| Life | Unum Life Insurance Company Of America | Engle, Hambright & Davies, Inc. | 340 | $11,228 6.1% of $183,819 |
| AD&D | Unum Life Insurance Company Of America | Engle, Hambright & Davies, Inc. | 73 | $2,025 15.7% of $12,859 |
| Attained Age Critical Illness | Unum Insurance Company | Engle, Hambright & Davies, Inc. | 33 | $1,516 16.4% of $9,242 |
| Grp Accident | Unum Insurance Company | Engle, Hambright & Davies, Inc. | 34 | $1,103 16.5% of $6,690 |
| Hospital Ee Paid | Unum Insurance Company | Engle, Hambright & Davies, Inc. | 36 | $1,897 16.7% of $11,393 |
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 $-35,363
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Engle-Hambright & Davies, Inc | Broker | $78,813 | $198.02 |
| The Benecon Group | Broker | $48,859 | $122.76 |
| ConnectCare3 | Patient Advocate | $16,966 | $42.63 |
| Highmark Blue Shield (Central) | Admin | $-1 | $-0.00 |
| Capital Bluecross | Admin | $-180,000 | $-452.26 |