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Employer
408 Sheely Lane, Mechanicsburg, PA 17050 · EIN 23-2355230 · 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 $3,357
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 16 | Comp not disclosed Premium $109,990 |
| Dental + Vision | Capital Advantage Assurance Company | Insurance Coalition | 25 | $758 8.8% of $8,597 |
| Life | Dearborn Life Insurance Company | Pci Insurance Agency | 23 | $326 18.0% of $1,811 |
| Critical Illness, Accident | Colonial Life & Accident Insurance Company | Insurance Coalition Inc | 12 | $804 3.7% of $21,662 |
| Critical Illness, Accident | Colonial Life & Accident Insurance Company | Benechoice Enrollment Solutions | 12 | $661 3.1% of $21,662 |
| Critical Illness, Accident | Colonial Life & Accident Insurance Company | Lance A Bradley | 12 | $427 2.0% of $21,662 |
| Critical Illness, Accident | Colonial Life & Accident Insurance Company | Petrina Skiles | 12 | $381 1.8% of $21,662 |
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 $21,160
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Pci (Pa Chamber Insurance) | Broker | $7,407 | $296.28 |
| The Benecon Group, LLC | Broker | $4,062 | $162.48 |
| Capital Bluecross | Admin | $8,615 | $344.60 |
| ConnectCare3 | Patient Advocate | $1,076 | $43.04 |