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Employer
1007 East Spring Street, Titusville, PA 16354 · EIN 15-0282515 · 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 $117,302
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Aetna Life Insurance Company | Total Benefits Solutions LLC | 76 | $19,203 1.6% of $1,236,627 |
| Medical | Kaiser Foundation Health Plan Inc | Nfp Corporate Services (Ny) LLC | 50 | $30,675 5.0% of $613,502 |
| Medical | Selecthealth | Nfp Coporate Services Ny LLC | 280 | $25,629 1.5% of $1,708,596 |
| Medical | Blue Cross & Blue Shield Of Mississipppi | — | 53 | Comp not disclosed Premium $222,476 |
| Vision | Vision Service Plan | — | 353 | Comp not disclosed Premium $39,256 |
| Life | Sunlife Assurance Company Of Canada | Nfp Corporate Services (Ny) LLC | 400 | $39,222 8.8% of $447,604 |
| Life | Sunlife Assurance Company Of Canada | Nfp Insurance Services Inc | 400 | $1,453 0.3% of $447,604 |
| Other | Provident Life And Accident Insurance Company | Nfp Corporate Services (Ny) LLC | 1 | $264 19.0% of $1,391 |
| Other | Provident Life And Accident Insurance Company | Nfp Insurance Services Inc | 1 | $28 2.0% of $1,391 |
| Other | Provident Life And Accident Insurance Company | Nfp Corporate Services (Ny) LLC | 2 | $490 18.6% of $2,641 |
| Other | Provident Life And Accident Insurance Company | Nfp Insurance Services Inc | 2 | $45 1.7% of $2,641 |
| EAP | Great American Assurance Company | — | 88 | Comp not disclosed Premium $5,214 |
| EAP | Telus Health (Us) Ltd | — | — | Schedule A not provided |
| Mba Coverage | Cigna Health And Life Insurance Company | Nfp Corporate Services (Ny) LLC | 1 | $293 10.0% of $2,925 |
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.