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Employer
P O Box 6480, Harrisburg, PA 17112 · EIN 23-6537047 · 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.
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | The Union Labor Life Insurance Co | — | 406 | Comp not disclosed Premium $511,140 |
| Medical | Sierra Health And Life Insurance Company Inc | — | 190 | Comp not disclosed Premium $278,548 |
| Dental | United Concordia Companies Inc | — | — | Comp not disclosed Premium $30,662 |
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 $620,553
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| D H Evans Tpa LLC DBA Path Admin | None | $294,179 | $580.23 |
| Meritain Health | None | $111,216 | $219.36 |
| Benecard | None | $75,598 | $149.11 |
| Willig, Williams & Davidson | None | $69,417 | $136.92 |
| Packer Thomas | None | $20,172 | $39.79 |
| Mariner Institutional LLC | None | $18,750 | $36.98 |
| United Concordia | None | $13,118 | $25.87 |
| Pfm Advisors | None | $9,064 | $17.88 |
| Sav-Rx | None | $9,039 | $17.83 |