Loading employer…
Employer
100 Hospital Avenue, Dubois, PA 15801 · EIN 32-0345810 · Jan 1, 2025 to Dec 31, 2025
Plan year 2025
View
Schedule A
Coverage contracts on the filing. If the carrier did not provide Schedule A, the row is listed with that note.
Visible subtotal $733,380
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Metropolitan Life Insurance Company | Boon Chapman Benefit Administrators | 2124 | $7,244 3.4% of $211,144 |
| Medical | Metropolitan Life Insurance Company | Mark Mettille | 2124 | $60,903 28.8% of $211,144 |
| Medical | Metropolitan Life Insurance Company | Gis Benefits Inc | 2124 | $14,488 6.9% of $211,144 |
| Medical | Metropolitan Life Insurance Company | Mark Mettille | 1633 | $56,382 14.7% of $383,797 |
| Medical | Metropolitan Life Insurance Company | Gis Benefits Inc | 1633 | $26,040 6.8% of $383,797 |
| Medical | Metropolitan Life Insurance Company | Boon Chapman Benefits Administrator | 1633 | $13,020 3.4% of $383,797 |
| Medical | Metropolitan Life Insurance Company | Mark Mettille | 1165 | $73,933 28.7% of $258,017 |
| Medical | Metropolitan Life Insurance Company | Gis Benefits Inc | 1165 | $17,315 6.7% of $258,017 |
| Medical | Metropolitan Life Insurance Company | Boon Chapman Benefit Administrators | 1165 | $8,658 3.4% of $258,017 |
| Vision | Vision Benefits Of America | — | 1083 | Comp not disclosed Premium $103,112 |
| Vision | Vision Benefits Of America | — | 2058 | Comp not disclosed Premium $376,341 |
| Life | Metropolitan Life Insurance Company | Gis Benefits | 6520 | $303,513 7.0% of $4,329,295 |
| Life | Metropolitan Life Insurance Company | Boon Chapman Benefit Administrators | 6520 | $151,884 3.5% of $4,329,295 |
| Fsa | Wageworks | — | 1179 | Comp not disclosed Premium $42,210 |
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.