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Employer
716 South Route 183, Schuylkill Haven, PA 17972 · EIN 23-2944586 · 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 $35,279
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Dental | United Concordia Insurance Company | Mather & Strohl Administrative | 329 | $13,511 14.8% of $91,319 |
| Dental | United Concordia Insurance Company | Mcconkey Benefits & Financial Servi | 329 | $1,814 2.0% of $91,319 |
| Vision | Vision Benefits Of America | Mcconkey Benefits & Financial Servi | 181 | $780 5.0% of $15,600 |
| AD&D | Sun Life Assurance Company Of Canada | Eta Benefits, Inc. | 2 | $19,174 12.9% of $148,294 |
| Stop-loss | Avalon Insurance Company | — | 183 | Comp not disclosed Premium $346,441 |
| Stop-loss | Everest Reinsurance Company | — | 185 | Comp not disclosed Premium $96,312 |
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 $67,595
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group, LLC | Broker | $2,739 | $14.81 |
| Mcconkey Benefits & Financial Serv | Admin | $63,531 | $343.41 |
| Benefitmall | Admin | $12,989 | $70.21 |
| Capital Blue Cross | Admin | $-11,664 | $-63.05 |