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Employer
2009 Mackenzie Way, Cranberry Township, PA 16066 · EIN 25-1199642 · 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 $29,967
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Dental | Delta Dental Of Pennsylvania | — | 305 | Comp not disclosed Premium $115,486 |
| Vision | Vision Service Plan | — | 266 | Comp not disclosed Premium $33,343 |
| Life | Life Insurance Company Of North America | Seubert & Associates | 464 | $5,162 6.8% of $75,868 |
| Life | Life Insurance Company Of North America | Assured Partners (Central Pa) | 464 | $2,424 3.2% of $75,868 |
| Life | Life Insurance Company Of North America | Archon, LLC | 464 | $2,581 3.4% of $75,868 |
| AD&D | Life Insurance Company Of North America | Seubert & Associates | 461 | $246 6.9% of $3,581 |
| AD&D | Life Insurance Company Of North America | Assured Partners (Central Pa) | 461 | $112 3.1% of $3,581 |
| AD&D | Life Insurance Company Of North America | Archon LLC | 461 | $123 3.4% of $3,581 |
| Other | Life Insurance Company Of North America | Seubert & Associates | 461 | $3,223 6.7% of $47,933 |
| Other | Life Insurance Company Of North America | Assured Partners (Central Pa) | 461 | $1,570 3.3% of $47,933 |
| Other | Life Insurance Company Of North America | Archon LLC | 461 | $1,612 3.4% of $47,933 |
| Other | Life Insurance Company Of North America | Seubert & Associates | 461 | $6,477 6.7% of $96,755 |
| Other | Life Insurance Company Of North America | Assured Partners (Central Pa) | 461 | $3,199 3.3% of $96,755 |
| Other | Life Insurance Company Of North America | Archon LLC | 461 | $3,238 3.3% of $96,755 |
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.
Visible subtotal $213,209
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Cigna Health And Life Insurance Co. | Medical Fees | $213,209 | $406.89 |