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Employer
P.O. Box 739, East Butler, PA 16029 · EIN 87-2449116 · 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 $18,469
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Blue Cross And Blue Shield Of Alabama | — | 86 | Comp not disclosed Premium $370,617 |
| Dental | Delta Dental Of Pennsylvania | — | 155 | Comp not disclosed Premium $53,025 |
| Vision | Metropolitan Life Insurance Company | — | 230 | Comp not disclosed Premium $14,114 |
| Life | Life Insurance Company Of North America | — | — | Schedule A not provided |
| Accidental Death And Dismemberment | Life Insurance Company Of North America | — | — | Schedule A not provided |
| Other | Life Insurance Company Of North America | — | — | Schedule A not provided |
| Other | Life Insurance Company Of North America | — | — | Schedule A not provided |
| Voluntary Worksite Plans | Unum Life Insurance Company Of America | Ioa Northeast, Inc. | 102 | $2,317 14.3% of $16,169 |
| Voluntary Worksite Plans | Unum Life Insurance Company Of America | Nylife Securities LLC | 102 | $154 1.0% of $16,169 |
| Voluntary Worksite Plans | Unum Life Insurance Company Of America | Marsh & Mclennan Agency, LLC East | 102 | $57 0.4% of $16,169 |
| Legal Services Plan Memberships | Pre-Paid Legal Services Inc. DBA Legalshield | Insurance Office Of America Inc. | 4 | $69 10.0% of $693 |
| Legal Services Plan Memberships | Pre-Paid Legal Services Inc. DBA Legalshield | Barry Olfern And Assoc. Inc. | 4 | $49 7.1% of $693 |
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.