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Employer
1705 S Braddock Avenue, Edgewood, PA 15218 · EIN 25-1394610 · Jan 1, 2021 to Dec 31, 2021
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 $11,957
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Upmc Health Plan | C B Tracy & Associates DBA Tracyco | 15 | $3,957 4.8% of $82,399 |
| Medical | Upmc Health Plan | C B Tracy & Associates DBA Tracyco | 10 | $3,580 5.1% of $70,090 |
| Medical | Upmc Health Plan | C B Tracy & Associates DBA Tracyco | 4 | $1,126 4.8% of $23,329 |
| Medical | Upmc Health Plan | C B Tracy & Associates DBA Tracyco | 1 | $6 9.8% of $61 |
| Medical | Upmc Health Plan | C B Tracy & Associates DBA Tracyco | 46 | $1,292 10.0% of $12,975 |
| Medical | Upmc Health Plan | C B Tracy & Associates DBA Tracyco | — | Comp not disclosed |
| Medical | Upmc Health Plan | C B Tracy & Associates DBA Tracyco | — | Comp not disclosed |
| Medical | Upmc Health Plan | C B Tracy & Associates DBA Tracyco | — | Comp not disclosed |
| Medical | Upmc Health Plan | C B Tracy & Associates DBA Tracyco | — | Comp not disclosed |
| Medical | Upmc Health Plan | C B Tracy & Associates DBA Tracyco | — | Comp not disclosed |
| Vision | Vision Benefits Of America | C B Tracy & Associates DBA Tracyco | 41 | $950 24.5% of $3,880 |
| Life | Standard Insurance Company | C B Tracy & Associates DBA Tracyco | 76 | $1,046 11.1% of $9,464 |
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.