Employer
Affiliated Supervalu Retail Outlets Welfare Plan
506 Pellis Rd, Greensburg, PA 15601 · EIN 25-1805823 · Sep 1, 2024 to Aug 31, 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 $1,276
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Life | Sun Life Assurance Company Of Canada | C B Tracy & Associates DBA Tracyco | 393 | $1,276 5.2% of $24,691 |
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 $38,036
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Sun Life Assurance Co Of Canada | Claims Processing | $15,893 | $36.70 |
| C B Tracy & Associates Inc | Contract Administrator | $12,393 | $28.62 |
| Deluzio & Company LLP | Auditing Services | $9,750 | $22.52 |