Form 5500 · Employee benefit plan · HARRISBURG, PA
CPA PAVEMENT SERVICES, INC.
The filing calls this plan CPA PAVEMENT SERVICES, INC. EMPLOYEE BENEFIT PLAN.
CPA PAVEMENT SERVICES, INC. of HARRISBURG, PA files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Its broker of record is MICHAEL P WALTON. Coverage is written through HM LIFE INSURANCE COMPANY and 2 other carriers. The plan's most recent policy period ended in June.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 27-5300679 · plan 501 · plan year 2025, filed Dec 8, 2025
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How this plan is funded
Self-funded as reported
The filing reports benefits paid from the plan's own money, and no medical insurance contract on Schedule A.
A stop-loss policy appears on a Form 5500 only when the plan itself is the beneficiary, or the premiums are paid from plan money. Many employers buy stop-loss and never report it here. So a plan with no stop-loss on its filing may still have it.
Benefits declared on this filing
Also declared: other welfare.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 3 insured contracts covering dental, vision, life, disability and stop-loss; the largest, with HM LIFE INSURANCE COMPANY, covers 35 people.
The filing declares dental, vision, life, disability and health. Health appears with no insured contract on Schedule A. That coverage may be self-funded, or placed with a carrier that is not on this filing.
The only insured piece of the health benefit is stop-loss coverage, and the filing reports the plan paying its own claims. The stop-loss contract reports $173,295 in premium and $0 in commission. The rest of the premium and commission above is on the plan's other insured lines, and none of it is medical premium.
Reported premium across the insured contracts is $241,415, with $7,279 in disclosed broker commissions — about 3% of premium.
The most recent policy period ended in June, and the plan year ends June 30. Group contracts typically renew on that annual cycle.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| UNUM LIFE INSURANCE COMPANY OF AMERICA | Life, Disability | 43 | Jul 1, 2025 | $52,693 | $5,678 |
| STARMOUNT LIFE INSURANCE COMPANY | Dental, Vision | 31 | Jul 1, 2025 | $15,427 | $1,601 |
| HM LIFE INSURANCE COMPANY | Stop-loss | 35 | Jul 1, 2025 | $173,295 | $0 |
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
Named on Schedule C of this filing. We publish company names only.
Money the plan held and paid out
Sourced from U.S. DOL EFAST2 Form 5500 · Schedule I
These are the plan's own figures from Schedule H, the financial statement it files. They are not the premium on Schedule A.
How this plan compares
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