Employer

Arctic Glacier U. S. A., Inc.

307 23rd St Ext Ste 950, Sharpsburg, PA 15215 · EIN 46-0527958 · Jan 1, 2024 to Dec 31, 2024

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 $21,432

Coverage	Carrier	Broker	Lives	Direct comp
Stop-loss	Aetna Life Insurance Company	Lockton Companies, LLC	361	$2,893 0.4% of $688,892
Dental + Vision	National Guardian Life Insurance Company	Mylo, LLC	117	$242 5.7% of $4,249
Dental + Vision	National Guardian Life Insurance Company	Marsh & Mclennan Agency, LLC East	117	$185 4.4% of $4,249
Vision	Aetna Life Insurance Company	Marsh & Mclennan Agency, LLC East	606	$4,058 9.0% of $45,091
Vision	Aetna Life Insurance Company	Lockton Companies, LLC	606	$2,020 4.5% of $45,091
Life	New York Life (Life Insurance Company Of North America)	Marsh & Mclennan Agency, LLC East	569	$146 0.1% of $168,998
Other	New York Life (Life Insurance Company Of North America)	Marsh & Mclennan Agency, LLC East	136	$143 0.2% of $79,597
Hospital Indemnity	Metlife Insurance Company	Lockton Companies, LLC	9	$615 20.0% of $3,074
Accidental Death And Dismemberment	New York Life (Life Insurance Company Of North America)	Marsh & Mclennan Agency, LLC East	569	$9 0.0% of $20,143
Accident	Metlife Insurance Company	Lockton Companies, LLC	9	$234 20.1% of $1,166
Accident, Critical Illness, Hopsital Indemnity	Aetna Health, Inc.	Marsh & Mclennan Agency, LLC East	279	$9,200 14.8% of $61,966
Other	New York Life (Life Insurance Company Of North America)	Lockton Companies, LLC	569	$1,680 1.7% of $97,634
Other	New York Life (Life Insurance Company Of North America)	Marsh & Mclennan Agency, LLC East	569	$7 0.0% of $97,634

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.

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