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Employer
One F.N.B. Boulevard, Hermitage, PA 16148 · EIN 25-1255406 · 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.
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Keystone Health Plan West, Inc. | — | 21 | Comp not disclosed Premium $68,847 |
| Vision | Fidelity Security Life Insurance Company | — | 6022 | Comp not disclosed Premium $559,740 |
| Vision | Fidelity Security Life Insurance Company | — | 81 | Comp not disclosed Premium $6,884 |
| Life | Lincoln National Life Insurance Company | — | 3900 | Comp not disclosed Premium $1,555,539 |
| AD&D | Federal Insurance Company | — | 6 | Comp not disclosed Premium $8,910 |
| Other | Lincoln National Life Insurance Company | — | 3892 | Comp not disclosed Premium $892,348 |
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 $2,004,372
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Highmark Inc. | None | $1,166,047 | $193.63 |
| Express Scripts | None | $471,683 | $78.33 |
| United Concordia Companies, Inc. | None | $217,705 | $36.15 |
| Lincoln National Life Insurance Co | None | $144,137 | $23.94 |
| Total Management Solutions, Inc. | None | $4,800 | $0.80 |