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Employer
77 North Hetrick Avenue, Palmyra, PA 17078 · EIN 23-2084455 · Feb 1, 2024 to Jan 31, 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 $14,840
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Everest Reinsurance Company | — | 101 | Comp not disclosed Premium $52,104 |
| Stop-loss | Avalon Insurance Company | — | 104 | Comp not disclosed Premium $270,133 |
| Dental | Delta Dental Of Pennsylvania | Mcconkey Benefits & Financial Servi | 137 | $1,400 4.1% of $34,276 |
| Dental | Delta Dental Of Pennsylvania | Benefitmall | 137 | $391 1.1% of $34,276 |
| Vision | National Vision Administrators, LLC (Heartland) | Mcconkey Benefits & Financial Servi | 157 | $597 9.1% of $6,564 |
| Life | United Of Omaha Life Insurance Company | Mcconkey Benefits & Financial Servi | 128 | $3,994 16.1% of $24,805 |
| Life | United Of Omaha Life Insurance Company | Benefitmall | 128 | $799 3.2% of $24,805 |
| Life | United Of Omaha Life Insurance Company | Gi George Parent Lp | 128 | $381 1.5% of $24,805 |
| Other | United Of Omaha Life Insurance Company | Mcconkey Benefits & Financial Servi | 36 | $2,102 21.3% of $9,875 |
| Other | United Of Omaha Life Insurance Company | Benefitmall | 36 | $296 3.0% of $9,875 |
| Other | United Of Omaha Life Insurance Company | Gi George Parent Lp | 36 | $178 1.8% of $9,875 |
| Other | United Of Omaha Life Insurance Company | United Of Omaha Life Insurance Comp | 100 | $4,423 |
| Other | United Of Omaha Life Insurance Company | Mcconkey Benefits & Financial Servi | 100 | $217 |
| Other | United Of Omaha Life Insurance Company | Gi George Parent Lp | 100 | $62 |
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 $75,647
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Mcconkey Benefits & Financial Serv | Broker | $36,562 | $351.56 |
| The Benecon Group, LLC | Broker | $1,478 | $14.21 |
| Highmark | Admin | $30,104 | $289.46 |
| Benefitmall | Admin | $7,503 | $72.14 |