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Employer
604 Hemlock Rd, Morgantown, PA 19543 · EIN 23-2103401 · Oct 1, 2020 to Sep 30, 2021
Plan year 2020
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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 $59,417
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Capital Advantage Assurance Company | Kistler Tiffany Benefits Co | 177 | $44,350 4.1% of $1,077,691 |
| Dental | Metropolitan Life Insurance Company | Kistler Tiffany Benefits Co | 228 | $2,702 5.1% of $52,879 |
| Dental | Metropolitan Life Insurance Company | Kistler Tiffany Benefits Co | 228 | $1,452 2.7% of $52,879 |
| Life | Lincoln National Life Insurance Co | Shore Benefits, Inc. | 127 | $2,457 10.2% of $24,020 |
| Life | Lincoln National Life Insurance Co | North American Benefits Co | 127 | $1,948 8.1% of $24,020 |
| Life | Lincoln National Life Insurance Co | William O Daggett Jr | 127 | $1,298 5.4% of $24,020 |
| Life | Lincoln National Life Insurance Co | Kistler Tiffany Benefits Co | 127 | $723 3.0% of $24,020 |
| Life | American United Life | Shore Benefits, Inc. | 135 | $1,666 9.9% of $16,786 |
| Life | American United Life | North American Benefits Company | 135 | $1,429 8.5% of $16,786 |
| Life | American United Life | William O. Daggett Jr. | 135 | $891 5.3% of $16,786 |
| Life | American United Life | Kistler Tiffany Benefits Co | 135 | $501 3.0% of $16,786 |
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.
Visible subtotal $325
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Fidelity Investments Institutional | Recordkeeper | $325 | $2.30 |
| Triad Advisors LLC | Advisor | Comp not disclosed | — |