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Employer
3650 West Market Street, York, PA 17404 · EIN 23-3101686 · Jul 1, 2024 to Jun 30, 2025
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 $60,581
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optum Health Unimerica Insurance Company | — | — | Comp not disclosed Premium $162 |
| Stop-loss | HM Life Insurance Company | — | 166 | Comp not disclosed Premium $482,567 |
| Dental | Metropolitan Life Insurance Company | Engle, Hambright & Davies, Inc. | 288 | $8,583 10.4% of $82,886 |
| Dental | Metropolitan Life Insurance Company | James R Nelligan & Associates | 288 | $5,073 6.1% of $82,886 |
| Vision | Vision Benefits Of America | Engle, Hambright & Davies, Inc. | 69 | $658 8.0% of $8,224 |
| Vision | Vision Benefits Of America | Engle, Hambright & Davies, Inc. | 92 | $618 8.0% of $7,723 |
| Life | Symetra Life Insurance Company | — | — | Schedule A not provided |
| Life | Symetra Life Insurance Company | — | — | Schedule A not provided |
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 $85,342
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Engle-Hambright & Davies, Inc | Broker | $45,740 | $251.32 |
| The Benecon Group, LLC | Broker | $34,089 | $187.30 |
| ConnectCare3 | Patient Advocate | $11,819 | $64.94 |
| Capital Bluecross | Admin | $-6,306 | $-34.65 |