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Employer
31 Old Cabin Hollow Road, Dillsburg, PA 17019 · EIN 22-1934229 · Nov 1, 2024 to Oct 31, 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.
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 34 | Comp not disclosed Premium $95,671 |
| Life | United Of Omaha Life Insurance Company | — | — | Schedule A not provided |
| Life | United Of Omaha Life Insurance Company | — | — | Schedule A not provided |
| Other | United Of Omaha Life Insurance Company | — | — | Schedule A not provided |
| Other | United Of Omaha Life Insurance Company | — | — | Schedule A not provided |
| Voluntary | United Of Omaha Life Insurance Company | — | — | Schedule A not provided |
| Voluntary | United Of Omaha Life Insurance Company | — | — | Schedule A not provided |
| Supplemental | Aflac | — | — | Schedule A not provided |
| Supplemental | Aflac | — | — | Schedule A not provided |
| Supplemental | Aflac | — | — | Schedule A not provided |
| Supplemental | Aflac | — | — | Schedule A not provided |
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 $39,095
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group | Broker | $22,224 | $584.84 |
| Brown & Brown Pa | Broker | $11,968 | $314.95 |
| Capital Blue Cross | Admin | $3,731 | $98.18 |
| Innovu | Other | $1,172 | $30.84 |