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Employer
71 Ashland Avenue, Carlisle, PA 17013 · EIN 23-1489837 · Apr 1, 2024 to Mar 31, 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 $28,383
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Dental | United Concordia Insurance Company | Mather & Stohl Administrative Servi | 188 | $5,977 10.5% of $57,074 |
| Dental | United Concordia Insurance Company | Mcconkey Benefits & Financial Servi | 188 | $946 1.7% of $57,074 |
| Vision | Vision Benefits Of America | Mcconkey Benefits & Financial Servi | 165 | $301 2.0% of $15,039 |
| Life | Life Insurance Company Of North America | — | — | Schedule A not provided |
| Life | Life Insurance Company Of North America | — | — | Schedule A not provided |
| AD&D | Life Insurance Company Of North America | — | — | Schedule A not provided |
| AD&D | Life Insurance Company Of North America | — | — | Schedule A not provided |
| Other | Life Insurance Company Of North America | — | — | Schedule A not provided |
| Other | Life Insurance Company Of North America | — | — | Schedule A not provided |
| Other | Life Insurance Company Of North America | — | — | Schedule A not provided |
| Other | Life Insurance Company Of North America | — | — | Schedule A not provided |
| Stop-loss | Avalon Insurance Company | — | 154 | Comp not disclosed Premium $630,197 |
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 $43,783
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Mcconkey Benefits & Financial Servi | Broker | $52,894 | $343.47 |
| Benefit Mall Tpa | Broker | $10,943 | $71.06 |
| The Benecon Group LLC | Broker | $1,826 | $11.86 |
| Capital Blue Cross | Admin | $-21,880 | $-142.08 |