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Employer
2000 Blue Mountain Pkwy, Harrisburg, PA 17112 · EIN 23-1494759 · Jul 1, 2023 to Jun 30, 2024
Plan year 2023
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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 $5,985
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Everest Reinsurance Company | — | — | Comp not disclosed Premium $1,425 |
| Stop-loss | HM Life Insurance Company | — | 60 | Comp not disclosed Premium $285,009 |
| Dental | United Concordia Insurance Company | Gunn Mowery, LLC | 110 | $3,270 9.6% of $33,986 |
| Dental | United Concordia Insurance Company | Colonial Park Realty, Co. | 110 | $32 0.1% of $33,986 |
| Vision | Capital Advantage Assurance Company | — | 102 | Comp not disclosed Premium $4,747 |
| Life | Unum Life Insurance Company Of America | Gunn Mowery, LLC | 92 | $179 10.0% of $1,795 |
| AD&D | Unum Life Insurance Company Of America | Gunn Mowery, LLC | 10 | $230 15.0% of $1,535 |
| Other | Unum Life Insurance Company Of America | Gunn Mowery, LLC | 92 | $1,339 15.0% of $8,925 |
| Other | Unum Life Insurance Company Of America | Gunn Mowery, LLC | 13 | $935 15.0% of $6,231 |
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 $48,388
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group, LLC | Broker | $17,691 | $160.83 |
| Gunn Mowery | Broker | $16,944 | $154.04 |
| Enders Insurance Associates | Broker | $48 | $0.44 |
| Capital Bluecross | Admin | $9,840 | $89.45 |
| ConnectCare3 | Patient Advocate | $3,865 | $35.14 |