Employer
Star Rock Services
175 Chestnut Grove Road, Conestoga, PA 17516 · EIN 27-0219839 · Jun 1, 2024 to May 31, 2025
Plan year 2024
Covered lives: 51
Schedule A
Direct compensation
Coverage contracts on the filing. If the carrier did not provide Schedule A, the row is listed with that note.
Visible subtotal $6,347
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Everest Reinsurance Company | — | — | Comp not disclosed Premium $898 |
| Stop-loss | Avalon Insurance Company | — | 50 | Comp not disclosed Premium $255,382 |
| Medical | Dominion National | Gunn-Mowery | 31 | $3,400 11.3% of $30,082 |
| Dental | Aflac | Gunn-Mowery | 4 | $135 3.3% of $4,085 |
| Dental | Aflac | Jonathon R Seele | 4 | $78 1.9% of $4,085 |
| Dental | Aflac | Dianne L Martin | 4 | $35 0.9% of $4,085 |
| Dental | Aflac | Anthony S Almodovar | 4 | $35 0.9% of $4,085 |
| Dental | Aflac | Glorianna Soraya Hita-Vargas | 4 | $23 0.6% of $4,085 |
| Dental | Aflac | Jeffrey R Stauffer | 4 | $18 0.4% of $4,085 |
| Dental | Aflac | Chris H Robinson | 4 | $13 0.3% of $4,085 |
| Dental | Aflac | Kenneth L Good | 4 | $10 0.2% of $4,085 |
| Dental | Aflac | Gerald L Walsh | 4 | $9 0.2% of $4,085 |
| Dental | Aflac | Kristin R Weeks | 4 | $8 0.2% of $4,085 |
| Dental | Aflac | Jason E Ferger | 4 | $7 0.2% of $4,085 |
| Dental | Aflac | Matthew G Berger | 4 | $2 0.0% of $4,085 |
| Dental | Aflac | Darren D Riddle | 4 | $1 0.0% of $4,085 |
| Dental | Aflac | Ryan K Goldberg | 4 | $1 0.0% of $4,085 |
| Dental | Aflac | Angela Umosella | 4 | $1 0.0% of $4,085 |
| Dental | Aflac | Martin E Bystrom | 4 | $1 0.0% of $4,085 |
| Dental | Aflac | Christopher A Lupp | 4 | $1 0.0% of $4,085 |
| Vision | Vision Benefits Of America | Gunn-Mowery | 23 | $227 5.0% of $4,538 |
| Other | Life Insurance Company Of North America | — | 47 | Schedule A not provided |
| Other | Life Insurance Company Of North America | — | 47 | Schedule A not provided |
Schedule C
Additional compensation
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 $29,349
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Gunn-Mowery | Broker | $16,604 | $325.57 |
| The Benecon Group | Broker | $10,249 | $200.96 |
| ConnectCare3 | Patient Advocate | $2,520 | $49.41 |
| Capital Bluecross | Admin | $-24 | $-0.47 |