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Employer
8283 State Route 29, Montrose, PA 18801 · EIN 20-8066203 · Jan 1, 2022 to Dec 31, 2022
Plan year 2022
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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 $189,085
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Highmark Inc. | Emerson Reid LLC | 527 | $43,526 1.6% of $2,786,779 |
| Medical | Highmark Inc. | Mercer (Us), Inc. | 527 | $34,112 1.2% of $2,786,779 |
| Medical | Highmark Inc. | Mercer (Us), Inc. | 563 | $52,886 3.4% of $1,576,182 |
| Dental | Metropolitan Life Insurance Company | Mercer (Us), Inc. | 780 | $7,985 3.9% of $206,627 |
| Dental | Metropolitan Life Insurance Company | Lockton Companies, LLC | 780 | $4,631 2.2% of $206,627 |
| Dental | Metropolitan Life Insurance Company | Mercer (Us), Inc. | 780 | $2,027 1.0% of $206,627 |
| Dental | Metropolitan Life Insurance Company | Lockton Companies, LLC | 780 | $2,014 1.0% of $206,627 |
| Dental | Metropolitan Life Insurance Company | Mercer (Us), Inc. | 780 | $2 0.0% of $206,627 |
| Dental | Metropolitan Life Insurance Company | Mercer (Us), Inc. | 815 | $7,291 6.3% of $115,150 |
| Accidental Death And Dismemberment | Zurich American Insurance Company | Mercer (Us), Inc. | 375 | $2,441 15.0% of $16,272 |
| Other | Standard Insurance Company | Mercer (Us), Inc. | 155 | $10,960 11.4% of $96,508 |
| Other | Standard Insurance Company | Lockton Companies, LLC | 155 | $4,806 5.0% of $96,508 |
| Other | Standard Insurance Company | Workday, Inc. | 155 | $2,895 3.0% of $96,508 |
| Other | Standard Insurance Company | Workday Inc. | 184 | $1,182 3.0% of $39,403 |
| Other | Standard Insurance Company | Mercer (Us), Inc. | 184 | $388 1.0% of $39,403 |
| Accidental Death And Dismemberment | Zurich American Life Insurance Company | Mercer (Us), Inc. | 375 | $1,374 15.0% of $9,161 |
| Other | Standard Insurance Company | Mercer (Us), Inc. | 156 | $7,924 15.0% of $52,824 |
| Other | Standard Insurance Company | Workday Inc | 156 | $1,585 3.0% of $52,824 |
| Other | Standard Insurance Company | Mercer (Us), Inc. | 156 | $1,056 2.0% of $52,824 |
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.