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Employer
4314 Us-209, Elizabethville, PA 17023 · EIN 59-3480511 · Apr 1, 2024 to Mar 31, 2025
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 $143,591
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Capital Advantage Assurance Company | American Insurance Administrators | 609 | $74,628 2.4% of $3,112,104 |
| Medical | Cigna Health And Life Insurance Company | Coury Health Services, LLC | 144 | $3,148 16.9% of $18,624 |
| Medical | Cigna Health And Life Insurance Company | Coury Health Services, LLC | 125 | $3,434 16.7% of $20,616 |
| Medical | Cigna Health And Life Insurance Company | Coury Health Services, LLC | 124 | $3,988 16.6% of $24,070 |
| Life | Life Insurance Company Of North America | Coury Health Services, LLC | 563 | $7,257 8.5% of $85,761 |
| Life | Life Insurance Company Of North America | Savoy Associates | 563 | $3,962 4.6% of $85,761 |
| Life | Life Insurance Company Of North America | Premier Consulting Partners | 563 | $1,339 1.6% of $85,761 |
| Life | Life Insurance Company Of North America | Willis Towers Watson | 563 | $996 1.2% of $85,761 |
| AD&D | Life Insurance Company Of North America | Coury Health Services, LLC | 511 | $926 10.0% of $9,257 |
| AD&D | Life Insurance Company Of North America | Savoy Associates | 511 | $386 4.2% of $9,257 |
| AD&D | Life Insurance Company Of North America | Premier Consulting Partners | 511 | $144 1.6% of $9,257 |
| AD&D | Life Insurance Company Of North America | Willis Towers Watson | 511 | $59 0.6% of $9,257 |
| Other | Life Insurance Company Of North America | Coury Health Services, LLC | 494 | $16,119 10.0% of $161,192 |
| Other | Life Insurance Company Of North America | Savoy Associates | 494 | $8,684 5.4% of $161,192 |
| Other | Life Insurance Company Of North America | Premier Consulting Partners | 494 | $2,505 1.6% of $161,192 |
| Other | Life Insurance Company Of North America | Willis Towers Watson | 494 | $1,912 1.2% of $161,192 |
| (Voluntary) | Life Insurance Company Of North America | Coury Health Services, LLC | 140 | $8,122 8.5% of $95,901 |
| (Voluntary) | Life Insurance Company Of North America | Savoy Associates | 140 | $3,224 3.4% of $95,901 |
| (Voluntary) | Life Insurance Company Of North America | Premier Consulting Partners | 140 | $1,586 1.7% of $95,901 |
| (Voluntary) | Life Insurance Company Of North America | Willis Towers Watson | 140 | $1,172 1.2% of $95,901 |
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.