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Employer
P.O. Box 8, York Haven, PA 17370 · EIN 23-1602205 · 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 $44,124
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Hcc Life Insurance Company | Trustmark Health Benefits, Inc. | 103 | $27,011 8.7% of $309,246 |
| Stop-loss | Hcc Life Insurance Company | Trustmark Health Benefits, Inc. | 103 | $1,428 0.5% of $309,246 |
| Medical | Principal Life Insurance Company | Edgewood Partners DBA Cook Maran | 135 | $8,621 9.2% of $93,404 |
| Vision | Vision Benefits Of America | Edgewood Partners Insurance Group | 101 | $527 6.4% of $8,286 |
| Cancer | Colonial Life & Accident Insurance Company | Benechoice Enrollment Solutions & T | 43 | $2,400 4.8% of $49,570 |
| Cancer | Colonial Life & Accident Insurance Company | Petrina Skiles | 43 | $1,737 3.5% of $49,570 |
| Cancer | Colonial Life & Accident Insurance Company | Edgewood Partners Insurance Center | 43 | $1,129 2.3% of $49,570 |
| Cancer | Colonial Life & Accident Insurance Company | Geesey Glatfelter Zar Agcy Inc | 43 | $461 0.9% of $49,570 |
| Cancer | Colonial Life & Accident Insurance Company | Gunn Mowery, LLC | 43 | $384 0.8% of $49,570 |
| Cancer | Colonial Life & Accident Insurance Company | James Bartlett LLC | 43 | $199 0.4% of $49,570 |
| Cancer | Colonial Life & Accident Insurance Company | Ashly Elcock | 43 | $109 0.2% of $49,570 |
| Cancer | Colonial Life & Accident Insurance Company | Cathy Good | 43 | $40 0.1% of $49,570 |
| Cancer | Colonial Life & Accident Insurance Company | Mcconkey Benefits & Financial Servi | 43 | $36 0.1% of $49,570 |
| Cancer | Colonial Life & Accident Insurance Company | Brent Mcvicker | 43 | $28 0.1% of $49,570 |
| Cancer | Colonial Life & Accident Insurance Company | William E Good | 43 | $11 0.0% of $49,570 |
| Cancer | Colonial Life & Accident Insurance Company | Ardena L Mcvicker | 43 | $3 0.0% of $49,570 |
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 $85,969
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Luminare Health Benefits, Inc. | None | $54,856 | $406.34 |
| Aetna - Asa | None | $19,013 | $140.84 |
| Rkl LLP | None | $12,100 | $89.63 |