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Employer
8085 Saltsburg Road, Plum, PA 15239 · EIN 20-3501516 · Jul 1, 2023 to Jun 30, 2024
Plan year 2023
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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 $34,258
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Principal Life Insurance Company | American Insurance Administrators | 125 | $1,631 5.5% of $29,913 |
| Medical | Principal Life Insurance Company | Coury Health Services, LLC | 125 | $2,107 7.0% of $29,913 |
| Medical | Principal Life Insurance Company | American Insurance Administrators | 125 | $749 2.5% of $29,913 |
| Medical | Highmark, Inc. | American Insurance Administrators | 87 | $17,864 3.3% of $548,575 |
| Vision | Vision Benefits Of America | Coury Health Services, LLC | 72 | $417 8.4% of $4,962 |
| Life | United Of Omaha Life Insurance Company | National Benefit Center | 99 | $152 6.3% of $2,429 |
| Life | United Of Omaha Life Insurance Company | American Insurance Administrators | 99 | $122 5.0% of $2,429 |
| Life | United Of Omaha Life Insurance Company | American Insurance Administrators | 99 | $395 16.3% of $2,429 |
| Life | United Of Omaha Life Insurance Company | National Benefit Center | 54 | $598 6.5% of $9,176 |
| Life | United Of Omaha Life Insurance Company | American Insurance Administrators | 54 | $459 5.0% of $9,176 |
| Life | United Of Omaha Life Insurance Company | American Insurance Administrators | 54 | $1,516 16.5% of $9,176 |
| Other | United Of Omaha Life Insurance Company | National Benefit Center | 99 | $654 6.0% of $10,832 |
| Other | United Of Omaha Life Insurance Company | American Insurance Administrators | 99 | $542 5.0% of $10,832 |
| Other | United Of Omaha Life Insurance Company | American Insurance Administrators | 99 | $2,279 21.0% of $10,832 |
| Other | United Of Omaha Life Insurance Company | National Benefit Center | 99 | $1,078 6.2% of $17,447 |
| Other | United Of Omaha Life Insurance Company | American Insurance Administrators | 99 | $872 5.0% of $17,447 |
| Other | United Of Omaha Life Insurance Company | American Insurance Administrators | 99 | $2,823 16.2% of $17,447 |
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.