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Employer
1379 Bucktail Road, St. Marys, PA 15857 · EIN 87-3820942 · Jul 1, 2022 to Jun 30, 2023
Plan year 2022
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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 $28,445
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Cigna Health And Life Insurance Company | Huntington Insurance Inc | 414 | $8,816 0.2% of $3,530,881 |
| Vision | Eyemed Vision Care On Behalf Of The Fidelity Security Life Ins Co. | Willis Towers Watson Northeast, Inc | 485 | $3,481 9.2% of $37,943 |
| Vision | Eyemed Vision Care On Behalf Of The Fidelity Security Life Ins Co. | Willis Of Massachusetts, Inc. | 485 | $641 1.7% of $37,943 |
| Life | Reliance Standard Life Insurance Company | Willis Towers Watson Northeast, Inc | 293 | $2,311 7.3% of $31,546 |
| Life | Reliance Standard Life Insurance Company | Willis Towers Watson | 293 | $277 0.9% of $31,546 |
| Life | Reliance Standard Life Insurance Company | Willis Towers Watson Northeast, Inc | 34 | $850 10.0% of $8,502 |
| Life | Reliance Standard Life Insurance Company | Willis Towers Watson | 34 | $70 0.8% of $8,502 |
| Life | Reliance Standard Life Insurance Company | Huntington Insurance Inc | 289 | $2,098 6.0% of $34,920 |
| Life | Reliance Standard Life Insurance Company | Willis Towers Watson Northeast, Inc | 289 | $350 1.0% of $34,920 |
| Life | Reliance Standard Life Insurance Company | Huntington Insurance Inc | 26 | $1,117 9.2% of $12,103 |
| Life | Reliance Standard Life Insurance Company | Willis Towers Watson Northeast, Inc | 26 | $81 0.7% of $12,103 |
| Life | Reliance Standard Life Insurance Company | Anderson And Kime Emp Benefits Inc | 26 | $12 0.1% of $12,103 |
| Other | Reliance Standard Life Insurance Company | Willis Towers Watson Northeast, Inc | 31 | $2,085 15.0% of $13,896 |
| Other | Reliance Standard Life Insurance Company | Willis Towers Watson | 31 | $122 0.9% of $13,896 |
| Accident | Reliance Standard Life Insurance Company | Willis Towers Watson Northeast, Inc | 40 | $1,275 15.1% of $8,431 |
| Accident | Reliance Standard Life Insurance Company | Willis Towers Watson | 40 | $76 0.9% of $8,431 |
| Accident | Reliance Standard Life Insurance Company | Huntington Insurance Inc | 40 | $-10 -0.1% of $8,431 |
| Critical Illness | Reliance Standard Life Insurance Company | Willis Towers Watson Northeast, Inc | 23 | $602 15.0% of $4,012 |
| Critical Illness | Reliance Standard Life Insurance Company | Willis Towers Watson | 23 | $35 0.9% of $4,012 |
| Other | Reliance Standard Life Insurance Company | Huntington Insurance Inc | 32 | $1,580 13.3% of $11,878 |
| Other | Reliance Standard Life Insurance Company | Willis Towers Watson Northeast, Inc | 32 | $202 1.7% of $11,878 |
| Accident | Reliance Standard Life Insurance Company | Huntington Insurance Inc | 21 | $1,453 13.8% of $10,567 |
| Accident | Reliance Standard Life Insurance Company | Willis Towers Watson Northeast, Inc | 21 | $132 1.2% of $10,567 |
| Critical Illness | Reliance Standard Life Insurance Company | Huntington Insurance Inc | 14 | $722 13.7% of $5,262 |
| Critical Illness | Reliance Standard Life Insurance Company | Willis Towers Watson Northeast, Inc | 14 | $67 1.3% of $5,262 |
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.