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Employer
650 Ridge Road, Ste 300, Pittsburgh, PA 15205 · EIN 23-1700500 · May 1, 2021 to Apr 30, 2022
Plan year 2021
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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 $1,215
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Avalon Insurance Company | — | — | Comp not disclosed Premium $192,584 |
| Medical | Capital Advantage Insurance Company | — | — | Comp not disclosed |
| Dental | Delta Dental Of Pennsylvania | Delaware Valley Health Care Coalit. | — | $1,215 0.3% of $365,590 |
| Vision | National Vision Administrators LLC | — | — | Comp not disclosed |
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 $700,060
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Capital Advantage Assurance Company | None | $338,275 | $215.87 |
| Express Scripts | None | $150,858 | $96.27 |
| Capital Advantage Insurance Company | None | $70,189 | $44.79 |
| Boyer & Ritter LLC | None | $60,269 | $38.46 |
| Mcnees Wallace & Nurick | None | $28,773 | $18.36 |
| Diana Schaeffer | None | $22,177 | $14.15 |
| Dawn Phillips | None | $11,832 | $7.55 |
| Conrad Siegel Inc | None | $9,054 | $5.78 |
| Ira Weinstock Pc | None | $8,633 | $5.51 |