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Employer
2301 Paxton Church Road, Harrisburg, PA 17110 · EIN 23-1687512 · 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 $17,268
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Life | Life Insurance Company Of North America | — | — | Schedule A not provided |
| Life | Life Insurance Company Of North America | — | — | Schedule A not provided |
| Accident | Life Insurance Company Of North America | — | — | Schedule A not provided |
| Accident | Life Insurance Company Of North America | — | — | Schedule A not provided |
| Other | Life Insurance Company Of North America | — | — | Schedule A not provided |
| Other | Life Insurance Company Of North America | — | — | Schedule A not provided |
| Stop-loss | Everest Reinsurance Company | — | 149 | Comp not disclosed Premium $164,195 |
| Stop-loss | Avalon Insurance Company | — | 157 | Comp not disclosed Premium $567,235 |
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 $-4,090
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| United Concordia, Inc. | Admin | $9,197 | $46.92 |
| Highmark | Admin | $-30,915 | $-157.73 |
| Mcconkey Benefits & Financial Serv | Broker | $48,642 | $309.82 |
| The Benecon Group | Broker | $2,118 | $13.49 |
| Benefitmall | Admin | $9,939 | $63.31 |
| Highmark | Admin | $-43,071 | $-274.34 |