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Employer
Po Box 600, Loretto, PA 15940 · EIN 25-1024358 · Jan 1, 2024 to Dec 31, 2024
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 $29,164
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Metropolitan Life Insurance Company | Usi Insurance Services (Ri) | 58 | $761 7.0% of $10,912 |
| Medical | Metropolitan Life Insurance Company | Usi Insurance Services (Ri) | 58 | $159 1.5% of $10,912 |
| Medical | Metropolitan Life Insurance Company | Usi Insurance Services (Ri) | 63 | $399 6.8% of $5,854 |
| Medical | Metropolitan Life Insurance Company | Usi Insurance Services (Ri) | 63 | $76 1.3% of $5,854 |
| Medical | Upmc Health Plan | — | 683 | Comp not disclosed Premium $4,676,406 |
| Dental | Metropolitan Life Insurance Company | Usi Insurance Services (Ri) | 471 | $6,171 5.1% of $119,895 |
| Dental | Metropolitan Life Insurance Company | Usi Insurance Services (Ri) | 471 | $1,227 1.0% of $119,895 |
| Dental | Sun Life Assurance Company Of Canada | Usi Insurance Services (Ri) | 273 | $18,162 12.4% of $146,694 |
| Vision | Vision Benefits Of America | Reschini Agency., Inc. | 319 | $2,209 3.0% of $73,623 |
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.