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Employer
100 Serrell Drive, Blairsville, PA 15717 · EIN 25-1094818 · Jan 1, 2021 to Dec 31, 2021
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 $10,631
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Upmc Health Options | — | — | Schedule A not provided |
| Medical | Upmc Health Options | — | 90 | Schedule A not provided |
| Medical | Upmc Health Options | — | 12 | Schedule A not provided |
| Medical | Upmc Health Options | — | — | Schedule A not provided |
| Medical | Upmc Health Options | — | — | Schedule A not provided |
| Medical | Upmc Health Options | — | — | Schedule A not provided |
| Dental + Vision | Upmc Health Benefits | — | 2 | Schedule A not provided |
| Dental + Vision | Upmc Health Benefits | — | — | Schedule A not provided |
| Dental + Vision | Upmc Health Benefits | — | 119 | Schedule A not provided |
| Dental + Vision | Upmc Health Benefits | — | — | Schedule A not provided |
| Life | United Of Omaha Life Insurance Company | Seubert & Associates Inc. | 74 | $544 14.0% of $3,892 |
| Voluntary Long-Term Disability | United Of Omaha Life Insurance Company | Seubert & Associates Inc. | 26 | $1,622 18.3% of $8,856 |
| Voluntary Term Life | United Of Omaha Life Insurance Company | Seubert & Associates Inc. | 48 | $3,803 18.4% of $20,625 |
| Other | United Of Omaha Life Insurance Company | Seubert & Associates Inc. | 7 | $459 18.2% of $2,517 |
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.