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Employer
Po Box 6480, Harrisburg, PA 17112 · EIN 24-6021385 · Jun 1, 2020 to May 31, 2021
Plan year 2020
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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 $6,632
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | The Union Labor Life Insurance Co. | — | 193 | Comp not disclosed Premium $716,918 |
| Medical | Sierra Health And Life Insurance Company, Inc. | — | 154 | Comp not disclosed Premium $116,908 |
| Vision | Highmark Blue Shield | — | 150 | Comp not disclosed Premium $18,025 |
| Life | Dearborn Life Insurance Company | Consolidated Benefits Inc | 198 | $6,632 15.5% of $42,913 |
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 $247,179
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Highmark | None | $89,505 | $438.75 |
| Segal Co. | None | $42,500 | $208.33 |
| Meyer Unkovic & Scott LLP | None | $38,624 | $189.33 |
| Path Administrators | None | $26,400 | $129.41 |
| Benecard | None | $17,081 | $83.73 |
| Andco Consulting | None | $15,000 | $73.53 |
| Fischer Dorwart, Pc | None | $10,000 | $49.02 |
| Kang Haggerty & Fetbroyt LLC | None | $7,638 | $37.44 |
| Wilmington Trust | None | $431 | $2.11 |