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Employer
25 D L Martine Drive, Mercersburg, PA 17236 · EIN 25-1185827 · 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 $12,627
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 88 | Comp not disclosed Premium $395,090 |
| Dental | United Concordia Insurance Company | Emerson Rogers LLC | 155 | $5,499 11.1% of $49,605 |
| Vision | Eyemed Vision Care | Brown & Brown Insurance Services In | 99 | $895 10.1% of $8,829 |
| Vision | National Vision Administrators, LLC | — | 1 | Comp not disclosed Premium $1,008 |
| Life | The Lincoln National Life Insurance Company | Brown & Brown Of Lehigh Valley | 110 | $1,627 9.9% of $16,514 |
| Life | The Lincoln National Life Insurance Company | Strategic Non-Medical Sltns LLC | 110 | $390 2.4% of $16,514 |
| Life | The Lincoln National Life Insurance Company | Brown & Brown Ins Services Inc | 110 | $328 2.0% of $16,514 |
| Other | The Lincoln National Life Insurance Company | Brown & Brown Of Lehigh Valley | 111 | $2,900 12.5% of $23,221 |
| Other | The Lincoln National Life Insurance Company | Strategic Non-Medical Sltns LLC | 111 | $554 2.4% of $23,221 |
| Other | The Lincoln National Life Insurance Company | Brown & Brown Ins Services Inc | 111 | $434 1.9% of $23,221 |
| EAP | M & S Eap | — | — | Schedule A not provided |
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 $115,868
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group | Broker | $77,128 | $497.60 |
| Brown & Brown (Pa) | Broker | $34,140 | $220.26 |
| Innovu | Other | $4,600 | $29.68 |