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Employer
460 Grim Lane, Suite 2, York, PA 17406 · EIN 20-1054401 · 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 $19,655
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Dental | Delta Dental | Mather & Strohl Admin Services | 75 | $4,270 10.0% of $42,704 |
| Vision | Vision Benefits Of America | Mcconkey Benefits & Financial Servi | 82 | $275 5.0% of $5,494 |
| Life | United Of Omaha Life Insurance Company | Mcconkey Benefits & Financial Servi | 100 | $221 10.4% of $2,133 |
| Life | United Of Omaha Life Insurance Company | Benefitmall | 100 | $64 3.0% of $2,133 |
| Life | United Of Omaha Life Insurance Company | Gi George Parent Lp | 100 | $44 2.1% of $2,133 |
| AD&D | United Of Omaha Life Insurance Company | Mcconkey Benefits & Financial Servi | 63 | $5,652 15.4% of $36,667 |
| AD&D | United Of Omaha Life Insurance Company | Benefitmall | 63 | $1,100 3.0% of $36,667 |
| AD&D | United Of Omaha Life Insurance Company | Gi George Parent Lp | 63 | $810 2.2% of $36,667 |
| EAP | Integrated Behavioral Health | — | — | Schedule A not provided |
| Voluntary Short Term Disability | United Of Omaha Life Insurance Company | Mcconkey Benefits & Financial Servi | 53 | $1,723 10.4% of $16,575 |
| Voluntary Short Term Disability | United Of Omaha Life Insurance Company | Benefitmall | 53 | $497 3.0% of $16,575 |
| Voluntary Short Term Disability | United Of Omaha Life Insurance Company | Gi George Parent Lp | 53 | $351 2.1% of $16,575 |
| Voluntary Accident | United Of Omaha Life Insurance Company | Mcconkey Benefits & Financial Servi | 52 | $1,038 10.4% of $9,987 |
| Voluntary Accident | United Of Omaha Life Insurance Company | Benefitmall | 52 | $300 3.0% of $9,987 |
| Voluntary Accident | United Of Omaha Life Insurance Company | Gi George Parent Lp | 52 | $207 2.1% of $9,987 |
| Voluntary Long Term Disability | United Of Omaha Life Insurance Company | Mcconkey Benefits & Financial Servi | 37 | $2,324 15.4% of $15,079 |
| Voluntary Long Term Disability | United Of Omaha Life Insurance Company | Benefitmall | 37 | $451 3.0% of $15,079 |
| Voluntary Long Term Disability | United Of Omaha Life Insurance Company | Gi George Parent Lp | 37 | $328 2.2% of $15,079 |
| Stop-loss | Avalon Insurance Company | — | 77 | Comp not disclosed Premium $352,581 |
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 $12,446
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Mcconkey Benefits & Financial Serv | Broker | $28,043 | $354.97 |
| The Benecon Group, LLC | Broker | $967 | $12.24 |
| Benefitmall | Admin | $5,961 | $75.46 |
| Capital Bluecross | Admin | $-22,525 | $-285.13 |