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Employer
506 Pellis Rd, Greensburg, PA 15601 · EIN 25-1805668 · Sep 1, 2024 to Aug 31, 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 $23,994
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Dental | United Concordia | Unmapped | 29 | $785 10.0% of $7,846 |
| Dental | United Concordia Insurance Company | C B Tracy & Associates DBA Tracyco | 62 | $2,777 10.0% of $27,769 |
| Dental + Vision | United Healthcare Insurance Company | Timothy S Helman | 24 | $1,025 10.6% of $9,677 |
| Dental + Vision | Upmc Health Benefits | C B Tracy & Associates DBA Tracyco | 82 | $1,399 9.4% of $14,954 |
| Dental + Vision | Upmc Health Benefits | C B Tracy & Associates DBA Tracyco | 342 | $12,972 9.4% of $138,099 |
| Life | Sun Life Assurance Company Of Canada | C B Tracy & Associates DBA Tracyco | 160 | $1,154 4.8% of $23,819 |
| Life | Sun Life Assurance Company Of Canada | C B Tracy & Associates DBA Tracyco | 214 | $3,195 5.4% of $59,314 |
| Life | Reliance Matrix | Mgis | 6 | $180 3.5% of $5,073 |
| Life | Reliance Matrix | C B Tracy & Associates DBA Tracyco | 6 | $507 10.0% of $5,073 |
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 $19,693
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Deluzio & Company LLP | Auditing Services | $9,750 | $28.51 |
| C B Tracy & Associates Inc | Contract Administrator | $6,157 | $18.00 |
| Sun Life Assurance Companyof Canada | Claims Processing | $3,786 | $11.07 |