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Employer
206 Siebert Road, Pittsburgh, PA 15237 · EIN 25-1474068 · 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 $9,691
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | — | Comp not disclosed Premium $1,551 |
| Stop-loss | Crum & Forster | — | 69 | Comp not disclosed Premium $264,470 |
| Vision | United Of Omaha Life Insurance Company | American Insurance Administrators | 63 | $636 9.3% of $6,809 |
| Vision | United Of Omaha Life Insurance Company | American Insurance Administrators | 63 | $408 6.0% of $6,809 |
| Vision | United Of Omaha Life Insurance Company | Alera General Agency Insurance Serv | 63 | $203 3.0% of $6,809 |
| Vision | United Of Omaha Life Insurance Company | American Insurance Administrators | 63 | $196 2.9% of $6,809 |
| Life | United Of Omaha Life Insurance Company | Alera Group Inc Coury Health Sv | 88 | $1,112 10.0% of $11,120 |
| Life | United Of Omaha Life Insurance Company | Alera Group Inc Coury Health Sv | 88 | $627 5.6% of $11,120 |
| Life | United Of Omaha Life Insurance Company | Alera General Agency Insurance Serv | 88 | $344 3.1% of $11,120 |
| Life | United Of Omaha Life Insurance Company | American Insurance Administrators | 88 | $301 2.7% of $11,120 |
| AD&D | United Of Omaha Life Insurance Company | Alera Group Inc DBA Coury Health Sv | 19 | $277 10.0% of $2,765 |
| AD&D | United Of Omaha Life Insurance Company | Alera Group Inc DBA Coury Health Sv | 19 | $226 8.2% of $2,765 |
| AD&D | United Of Omaha Life Insurance Company | American Insurance Administrators | 19 | $98 3.5% of $2,765 |
| AD&D | United Of Omaha Life Insurance Company | Alera General Agency Insurance Serv | 19 | $73 2.6% of $2,765 |
| Other | United Of Omaha Life Insurance Company | American Insurance Administrators | 88 | $756 10.0% of $7,560 |
| Other | United Of Omaha Life Insurance Company | American Insurance Administrators | 88 | $457 6.0% of $7,560 |
| Other | United Of Omaha Life Insurance Company | Alera General Agency Insurance Serv | 88 | $233 3.1% of $7,560 |
| Other | United Of Omaha Life Insurance Company | American Insurance Administrators | 88 | $210 2.8% of $7,560 |
| Vol. Dental | United Of Omaha Life Insurance Company | American Insurance Administrators | 47 | $1,501 6.7% of $22,524 |
| Vol. Dental | United Of Omaha Life Insurance Company | American Insurance Administrators | 47 | $794 3.5% of $22,524 |
| Vol. Dental | United Of Omaha Life Insurance Company | Alera General Agency Insurance Serv | 47 | $668 3.0% of $22,524 |
| Vol. Dental | United Of Omaha Life Insurance Company | American Insurance Administrators | 47 | $571 2.5% of $22,524 |
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 $135,296
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group, LLC | Broker | $57,054 | $648.34 |
| Coury Health Services, LLC | Broker | $21,630 | $245.80 |
| Upmc Benefit Management Services | Admin | $42,936 | $487.91 |
| Revivehealth, Inc. | Other | $9,412 | $106.95 |
| Southern Scripts | Admin | $4,264 | $48.45 |