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Employer
330 East Cunningham Street, Butler, PA 16001 · EIN 88-0813020 · Jul 1, 2024 to Jun 30, 2025
Plan year 2024
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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 $14,603
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 35 | Comp not disclosed Premium $208,752 |
| Dental | United Of Omaha Life Insurance Company | Coury Health Sv | 34 | $1,328 6.9% of $19,171 |
| Dental | United Of Omaha Life Insurance Company | Alera Group Inc DBA Coury Health Sv | 34 | $703 3.7% of $19,171 |
| Dental | United Of Omaha Life Insurance Company | American Insurance Administrators | 34 | $100 0.5% of $19,171 |
| Life | United Of Omaha Life Insurance Company | Coury Health Sv | 35 | $2,068 10.0% of $20,681 |
| Life | United Of Omaha Life Insurance Company | American Insurance Administrators | 35 | $1,722 8.3% of $20,681 |
| Life | United Of Omaha Life Insurance Company | American Insurance Administrators | 35 | $246 1.2% of $20,681 |
| AD&D | United Of Omaha Life Insurance Company | Coury Health Sv | 21 | $913 10.0% of $9,130 |
| AD&D | United Of Omaha Life Insurance Company | Alera Group Inc DBA Coury Health Sv | 21 | $692 7.6% of $9,130 |
| AD&D | United Of Omaha Life Insurance Company | American Insurance Administrators | 21 | $99 1.1% of $9,130 |
| Voluntary Vision | United Of Omaha Life Insurance Company | Coury Health Sv | 29 | $460 10.0% of $4,601 |
| Voluntary Vision | United Of Omaha Life Insurance Company | American Insurance Administrators | 29 | $328 7.1% of $4,601 |
| Voluntary Vision | United Of Omaha Life Insurance Company | American Insurance Administrators | 29 | $47 1.0% of $4,601 |
| Vol Critical Illness | United Of Omaha Life Insurance Company | Coury Health Sv | 15 | $557 15.0% of $3,714 |
| Vol Critical Illness | United Of Omaha Life Insurance Company | Alera Group Inc DBA Coury Health Sv | 15 | $278 7.5% of $3,714 |
| Vol Critical Illness | United Of Omaha Life Insurance Company | American Insurance Administrators | 15 | $40 1.1% of $3,714 |
| Voluntary Accident | United Of Omaha Life Insurance Company | Coury Health Sv | 17 | $429 15.0% of $2,860 |
| Voluntary Accident | United Of Omaha Life Insurance Company | American Insurance Administrators | 17 | $230 8.0% of $2,860 |
| Voluntary Accident | United Of Omaha Life Insurance Company | American Insurance Administrators | 17 | $33 1.2% of $2,860 |
| Other | United Of Omaha Life Insurance Company | Coury Health Sv | 35 | $819 10.0% of $8,186 |
| Other | United Of Omaha Life Insurance Company | Alera Group Inc DBA Coury Health Sv | 35 | $572 7.0% of $8,186 |
| Other | United Of Omaha Life Insurance Company | American Insurance Administrators | 35 | $82 1.0% of $8,186 |
| Other | United Of Omaha Life Insurance Company | Coury Health Sv | 35 | $1,536 15.0% of $10,238 |
| Other | United Of Omaha Life Insurance Company | American Insurance Administrators | 35 | $708 6.9% of $10,238 |
| Other | United Of Omaha Life Insurance Company | American Insurance Administrators | 35 | $570 5.6% of $10,238 |
| Other | United Of Omaha Life Insurance Company | Alera General Agency | 35 | $43 0.4% of $10,238 |
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 $42,123
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group, LLC | Broker | $12,767 | $364.77 |
| Coury Health Services, LLC | Broker | $12,210 | $348.86 |
| Highmark West | Admin | $17,146 | $489.89 |