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Employer
Po Box 1258, Somerset, PA 15501 · EIN 47-1714818 · Feb 1, 2021 to Jan 31, 2022
Plan year 2021
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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 $52,552
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Highmark, Inc | American Insurance Administrators | 297 | $45,516 2.9% of $1,553,406 |
| Other | American Fidelity Assurance Company | Pennsylvania Auto Assoc Ins Agency | 1 | $646 2.9% of $22,360 |
| Accident, Cancer, Medical Group | American Fidelity Assurance Company | American Fidelity Assurance Co | 8 | $6 0.1% of $7,104 |
| Accident, Cancer, Medical Group | American Fidelity Assurance Company | Pennsylvania Auto Assoc Ins Agency | 8 | $442 6.2% of $7,104 |
| Accident, Group Hi/Gap, Medical Group | American Fidelity Assurance Company | Pennsylvania Auto Assoc Ins Agency | 16 | $815 5.9% of $13,777 |
| Accident, Cancer | American Fidelity Assurance Company | American Fidelity Assurance Co | 36 | $96 0.4% of $26,447 |
| Accident, Cancer | American Fidelity Assurance Company | Pennsylvania Auto Assoc Ins Agency | 36 | $1,960 7.4% of $26,447 |
| Accident, Cancer, Medical Group | American Fidelity Assurance Company | American Fidelity Assurance Co | 26 | $95 0.7% of $14,183 |
| Accident, Cancer, Medical Group | American Fidelity Assurance Company | Pennsylvania Auto Assoc Ins Agency | 26 | $944 6.7% of $14,183 |
| Accident, Medical Group, Cancer | American Fidelity Assurance Company | American Fidelity Assurance Co | 25 | $130 0.8% of $15,296 |
| Accident, Medical Group, Cancer | American Fidelity Assurance Company | Pennsylvania Auto Assoc Ins Agency | 25 | $973 6.4% of $15,296 |
| Accident, Cancer, Medical Group, Std | American Fidelity Assurance Company | Pennsylvania Auto Assoc Ins Agency | 25 | $929 5.7% of $16,423 |
| Other | American Fidelity Assurance Company | — | — | Comp not disclosed Premium $2,182 |
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.