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Employer
217 Titusville Road, Union City, PA 16438 · EIN 81-1706890 · Jun 1, 2024 to May 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 $30,983
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Highmark, Inc. | — | 182 | Comp not disclosed Premium $1,096,383 |
| Dental + Vision | Reliance Standard Life Insurance Company | Henderson Brothers Inc. | 297 | $2,858 5.6% of $50,643 |
| Dental + Vision | Reliance Standard Life Insurance Company | Watchtower Technologies, Inc. | 297 | $760 1.5% of $50,643 |
| Life | Reliance Standard Life Insurance Company | Henderson Brothers Inc. | 165 | $2,663 6.6% of $40,327 |
| Life | Reliance Standard Life Insurance Company | Watchtower Technologies, Inc. | 165 | $807 2.0% of $40,327 |
| AD&D | Reliance Standard Life Insurance Company | Henderson Brothers Inc. | 104 | $484 15.0% of $3,223 |
| AD&D | Reliance Standard Life Insurance Company | Watchtower Technologies, Inc. | 104 | $64 2.0% of $3,223 |
| Other | Highmark, Inc. | — | 86 | Comp not disclosed Premium $136,613 |
| Other | Reliance Standard Life Insurance Company | Henderson Brothers Inc. | 179 | $3,891 5.6% of $69,134 |
| Other | Reliance Standard Life Insurance Company | Watchtower Technologies, Inc. | 179 | $1,383 2.0% of $69,134 |
| Other | Reliance Standard Life Insurance Company | Henderson Brothers Inc. | 165 | $2,854 13.6% of $21,040 |
| Other | Reliance Standard Life Insurance Company | Watchtower Technologies, Inc. | 165 | $421 2.0% of $21,040 |
| Accident | Reliance Standard Life Insurance Company | Henderson Brothers Inc. | 45 | $7,422 60.0% of $12,371 |
| Accident | Reliance Standard Life Insurance Company | Watchtower Technologies, Inc. | 45 | $247 2.0% of $12,371 |
| Critical Illness | Reliance Standard Life Insurance Company | Henderson Brothers Inc. | 36 | $4,537 60.0% of $7,562 |
| Critical Illness | Reliance Standard Life Insurance Company | Watchtower Technologies, Inc. | 36 | $151 2.0% of $7,562 |
| Hospital Indemnity | Reliance Standard Life Insurance Company | Henderson Brothers Inc. | 19 | $2,362 60.0% of $3,937 |
| Hospital Indemnity | Reliance Standard Life Insurance Company | Watchtower Technologies, Inc. | 19 | $79 2.0% of $3,937 |
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.
No Schedule C parties in this year.