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Employer
100 Pine Street, Harrisburg, PA 17108 · EIN 23-1256003 · Jan 1, 2025 to Dec 31, 2025
Plan year 2025
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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 $21,681
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Avalon Insurance Company | — | 256 | Comp not disclosed Premium $543,997 |
| Vision | Vision Benefits Of America | — | 247 | Comp not disclosed Premium $22,626 |
| Life | Unum Life Insurance Company Of America | Gallagher Fiduciary Advisors, LLC | 309 | $6,147 1.7% of $365,577 |
| Life | Unum Life Insurance Company Of America | Gallagher Belmont | 309 | $3,730 1.0% of $365,577 |
| AD&D | Unum Life Insurance Company Of America | Gallagher Benefit Services Inc. | 116 | $10,146 14.1% of $72,183 |
| AD&D | Unum Life Insurance Company Of America | Gallagher Fiduciary Advisors, LLC | 116 | $1,658 2.3% of $72,183 |
| EAP | Mazzitti & Sullivan | — | 304 | 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 $97,080
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group | Broker | $135,535 | $438.62 |
| Revivehealth, Inc. | Other | $44,790 | $144.95 |
| United Concordia Companies, Inc. | Admin | $21,170 | $68.51 |
| Capital Advantage Assurance Company | Admin | $-104,415 | $-337.91 |