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Employer
650 Ridge Road, Suite 103, Pittsburgh, PA 15205 · EIN 23-7311912 · Jan 1, 2022 to Dec 31, 2022
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 $2,363
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 144 | Comp not disclosed Premium $243,048 |
| Dental | Delta Dental Of Pennsylvania | — | 223 | Comp not disclosed Premium $60,650 |
| Vision | Highmark Blue Cross Blue Shield | — | 240 | Comp not disclosed Premium $17,425 |
| Life | New York Life | Arms Insurance Group LLC | 142 | $2,363 14.9% of $15,819 |
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.
Visible subtotal $200,402
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Highmark | None | $94,182 | $392.43 |
| Cheiron Inc | None | $30,499 | $127.08 |
| Diclaudio & Kramer, LLC | None | $28,513 | $118.80 |
| Stephen J. O'Brien & Associates, Ll | None | $21,620 | $90.08 |
| Mary Taylor | None | $14,350 | $59.79 |
| Central Data Services | Contract Administrator | $5,400 | $22.50 |
| Standard Valuations | None | $5,000 | $20.83 |
| Tamsula Consulting | None | $838 | $3.49 |