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Employer
19 N Baltimore St, Dillsburg, PA 17019 · EIN 20-2003799 · Dec 1, 2024 to Nov 30, 2025
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 $12,383
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Avalon Insurance Company | — | 74 | Comp not disclosed Premium $261,988 |
| Dental | United Concordia Insurance Company | Gunn Mowery, LLC | 214 | $7,045 10.0% of $70,444 |
| Vision | Vision Benefits Of America | Gunn Mowery, LLC | 73 | $863 10.0% of $8,630 |
| Other | New York Life Insurance Company | Disability Rms | 74 | $1,220 16.0% of $7,623 |
| Other | New York Life Insurance Company | Walton, Michael | 74 | $1,144 15.0% of $7,623 |
| Other | New York Life Insurance Company | Walton, Michael | 74 | $1,056 15.0% of $7,036 |
| Other | New York Life Insurance Company | Disability Rms | 74 | $1,055 15.0% of $7,036 |
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 $35,252
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group | Broker | $25,501 | $119.16 |
| Gunn Mowery | Broker | $22,288 | $104.15 |
| ConnectCare3 | Admin. | $3,383 | $15.81 |
| Capital Bluecross | Admin. | $-15,920 | $-74.39 |