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Employer
434 Paxtonville Rd, Middleburg, PA 17842 · EIN 23-1662980 · Jun 1, 2020 to May 31, 2021
Plan year 2020
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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 $25,607
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Upmc Health Options | Emerson Reid & Co | 1 | $162 2.7% of $6,039 |
| Medical | Upmc Health Options | Emerson Reid & Co | 1 | $132 2.7% of $4,938 |
| Medical | Upmc Health Options | Emerson Reid & Co | 8 | $1,107 2.3% of $47,776 |
| Medical | Upmc Health Options | Emerson Reid & Co | 31 | $4,224 2.7% of $159,045 |
| Medical | Upmc Health Options | Emerson Reid & Co | 18 | $1,478 3.0% of $49,518 |
| Medical | Upmc Health Options | Emerson Reid & Co | 86 | $11,280 2.3% of $489,784 |
| Medical | Upmc Health Options | Emerson Reid & Co | — | Comp not disclosed |
| Medical | Upmc Health Options | Emerson Reid & Co | — | Comp not disclosed |
| Medical | Upmc Health Options | Emerson Reid & Co | — | Comp not disclosed |
| Medical | Upmc Health Options | Emerson Reid & Co | — | Comp not disclosed |
| Medical | Upmc Health Options | Emerson Reid & Co | 2 | $377 2.3% of $16,132 |
| Medical | Upmc Health Options | Emerson Reid & Co | — | Comp not disclosed |
| Dental | Delta Dental Of Pennsylvania | Sholley Agency | 203 | $2,284 5.0% of $45,688 |
| Vision | Vision Benefits Of America | — | 91 | Comp not disclosed Premium $8,639 |
| Life | United Of Omaha Life Insurance Company | Kafl Inc | 92 | $708 10.0% of $7,082 |
| Other | United Of Omaha Life Insurance Company | Kafl Inc | 92 | $1,679 10.0% of $16,792 |
| Other | United Of Omaha Life Insurance Company | Kafl Inc | 91 | $2,176 10.0% of $21,763 |
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.