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Employer
252 Pittsburgh Rd, Butler, PA 16002 · EIN 25-1059734 · Jul 1, 2024 to Jun 30, 2025
Plan year 2024
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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 $9,303
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 58 | Comp not disclosed Premium $63,378 |
| Dental | Principal Life Insurance Company | — | — | Schedule A not provided |
| Vision | Vision Benefits Of America | Engle, Hambright & Davies, Inc. | 63 | $92 5.0% of $1,834 |
| Life | Unum Life Insurance Company Of America | Engle, Hambright & Davies, Inc. | 107 | $229 13.3% of $1,718 |
| Life | Unum Life Insurance Company Of America | Assurex | 107 | Comp not disclosed Premium $1,718 |
| AD&D | Unum Life Insurance Company Of America | Engle, Hambright & Davies, Inc. | 6 | $175 21.0% of $834 |
| AD&D | Unum Life Insurance Company Of America | Assurex | 6 | Comp not disclosed Premium $834 |
| Cci; Accident; ; Life; Supp | Liberty Mutual | — | — | Schedule A not provided |
| Stop-loss | HM Life Insurance Company | — | 66 | Comp not disclosed Premium $350,371 |
| Medical | Principal Life Insurance Company | — | 213 | Schedule A not provided |
| Medical | Principal Life Insurance Company | — | 213 | Schedule A not provided |
| Vision | Vision Benefits Of America | Engle, Hambright & Davies, Inc. | 69 | $302 3.6% of $8,307 |
| Supplemental | Liberty Mutual | — | — | Schedule A not provided |
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 $54,604
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Engle-Hambright & Davies, Inc | Broker | $6,569 | $113.26 |
| The Benecon Group | Broker | $3,367 | $58.05 |
| ConnectCare3 | Pt Advocate | $9,075 | $156.47 |
| Highmark West | Admin | $-2,485 | $-42.84 |
| Engle-Hambright & Davies, Inc | Broker | $29,483 | $446.71 |
| The Benecon Group | Broker | $19,958 | $302.39 |
| Highmark Blue Shield (Central) | Admin | $-1,247 | $-18.89 |
| Highmark West | Admin | $-10,116 | $-153.27 |