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Employer
1667 E. Sutter Rd, Glenshaw, PA 15116 · EIN 25-1435582 · Jan 1, 2025 to Dec 31, 2025
Plan year 2025
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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 $20,690
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 41 | Comp not disclosed Premium $433,507 |
| Dental | Upmc Health Benefits | First Commonewealth Insurance Agenc | 90 | $2,641 10.2% of $25,992 |
| Vision | Vision Benefits Of America | Professional Group Plans | 42 | $178 5.0% of $3,555 |
| Vision | Vision Benefits Of America | First Commonwealth Insurance Agency | 42 | $178 5.0% of $3,555 |
| Life | United Of Omaha Life Insurance Company | First Commonwealth Insurance Agency | 52 | $2,809 20.0% of $14,047 |
| Life | United Of Omaha Life Insurance Company | Emerson Rogers LLC | 52 | $702 5.0% of $14,047 |
| AD&D | United Of Omaha Life Insurance Company | First Commonwealth Insurance Agency | 8 | $872 20.0% of $4,360 |
| AD&D | United Of Omaha Life Insurance Company | Emerson Rogers LLC | 8 | $218 5.0% of $4,360 |
| Other | United Of Omaha Life Insurance Company | First Commonwealth Insurance Agency | 49 | $7,423 20.0% of $37,113 |
| Other | United Of Omaha Life Insurance Company | Emerson Rogers LLC | 49 | $1,856 5.0% of $37,113 |
| Other | United Of Omaha Life Insurance Company | First Commonwealth Insurance Agency | 49 | $3,050 20.0% of $15,252 |
| Other | United Of Omaha Life Insurance Company | Emerson Rogers LLC | 49 | $763 5.0% of $15,252 |
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 $116,710
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group | Broker | $69,435 | $771.50 |
| First Commonwealth Insurance Agency | Broker | $18,640 | $207.11 |
| Upmc Benefit Management Services | Admin | $27,776 | $308.62 |
| Southern Scripts | Other | $859 | $9.54 |