Employer
West Shore Country Club
100 Brentwater Rd, Camp Hill, PA 17011 · EIN 23-1211520 · Dec 1, 2024 to Nov 30, 2025
Plan year 2024
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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 $4,863
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Avalon Insurance Company | — | 41 | Comp not disclosed Premium $186,074 |
| Dental | Guardian | — | 40 | Schedule A not provided |
| Dental | Guardian | — | 40 | Schedule A not provided |
| Dental | Guardian | — | 40 | Schedule A not provided |
| Vision | Highmark, Inc | Gunn Mowery, LLC | 51 | $189 6.1% of $3,109 |
| Life | Unum Life Insurance Company Of America | Krise Broeg & Boushell, LLC | 50 | $2,410 11.6% of $20,784 |
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 $34,228
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group | Broker | $17,350 | $340.20 |
| Gunn-Mowery | Broker | $14,862 | $291.41 |
| Connectcare 3 | Patient Advocate | $2,040 | $40.00 |
| Capital Blue Cross | Admin | $-24 | $-0.47 |