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Employer
124 Laurel Ave, Johnstown, PA 15906 · EIN 25-1694672 · Jan 1, 2020 to Dec 31, 2020
Plan year 2020
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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 $8,514
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Life | United Of Omaha Life Ins Co | Gallagher Fiduciary Advisors, LLC | 235 | $2,879 5.3% of $54,619 |
| Life | United Of Omaha Life Ins Co | Andrew R Rodgers Ins Agcy Inc | 235 | $944 1.7% of $54,619 |
| Life | United Of Omaha Life Ins Co | Gallagher Fiduciary Advisors, LLC | 235 | $3,252 6.0% of $54,619 |
| Accidental Death & Dismemberment | United Of Omaha Life Ins Co | Gallagher Fiduciary Advisors, LLC | 45 | $580 5.2% of $11,070 |
| Accidental Death & Dismemberment | United Of Omaha Life Ins Co | Andrew F Rodgers Ins Agcy Inc | 45 | $195 1.8% of $11,070 |
| Accidental Death & Dismemberment | United Of Omaha Life Ins Co | Gallagher Fiduciary Advisors, LLC | 45 | $664 6.0% of $11,070 |
| Medical | Upmc Health Network | — | 412 | Comp not disclosed Premium $2,652,039 |
| Medical | Upmc Health Network | — | 123 | Comp not disclosed Premium $627,467 |
| Medical | Upmc Health Benefits | — | 1 | Comp not disclosed Premium $3,470 |
| Medical | Upmc Health Network | — | 19 | Comp not disclosed Premium $128,816 |
| Medical | Upmc Health Network | — | 2 | Comp not disclosed Premium $24,390 |
| Medical | Upmc Health Network | — | 1 | Comp not disclosed Premium $1,324 |
| Dental + Vision | Upmc Health Benefits | — | 435 | Comp not disclosed Premium $133,023 |
| Dental + Vision | Upmc Health Benefits | — | 130 | Comp not disclosed Premium $32,271 |
| Dental + Vision | Upmc Health Benefits | — | 17 | Comp not disclosed Premium $6,194 |
| Dental + Vision | Upmc Health Benefits | — | 6 | Comp not disclosed Premium $3,270 |
| Dental + Vision | Upmc Health Benefits | — | 1 | Comp not disclosed Premium $189 |
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.