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Employer
740 Spang Street, Roaring Spring, PA 16673 · EIN 23-1023880 · 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 $33,140
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Upmc Health Options | Lr Webber | 14 | $2,869 1.7% of $166,752 |
| Medical | Upmc Health Options | Lr Webber | 7 | $924 1.6% of $57,441 |
| Medical | Upmc Health Options | Lr Webber | 6 | $1,279 1.6% of $79,371 |
| Medical | Upmc Health Options | Lr Webber | 49 | $6,368 1.6% of $395,937 |
| Medical | Upmc Health Options | Lr Webber | 21 | $2,903 1.6% of $177,498 |
| Medical | Upmc Health Options | Lr Webber | 76 | $10,800 1.6% of $664,048 |
| Medical | Upmc Health Options | Lr Webber | 2 | $308 1.4% of $22,399 |
| Medical | Upmc Health Options | Lr Webber | 2 | $20 9.4% of $212 |
| Medical | Upmc Health Benefits | Lr Webber | 53 | $2,215 9.4% of $23,627 |
| Medical | Upmc Health Benefits | Lr Webber | 21 | $701 9.4% of $7,450 |
| Medical | Upmc Health Benefits | Lr Webber | 42 | $1,435 9.5% of $15,110 |
| Life | Metropolitan Life Insurance Company | — | 223 | Comp not disclosed Premium $61,818 |
| Other | One America | Lr Webber | 67 | $3,318 10.7% of $30,920 |
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.