Employer

Emclaire Financial Corp.

612 Main Street, Emlenton, PA 16373 · EIN 25-0472020 · Jan 1, 2022 to Dec 31, 2022

Plan year 2022

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Schedule A

Direct compensation

Coverage contracts on the filing. If the carrier did not provide Schedule A, the row is listed with that note.

Visible subtotal $7,424

Coverage	Carrier	Broker	Lives	Direct comp
Dental	Sun Life Assurance Company Of Canada	Lr Webber	121	$2,631 4.8% of $55,217
Vision	National Vision Administrators, L.L.C.	Lr Webber	101	$776 5.0% of $15,522
Life	American United Life Insurance Company	Lr Webber	126	$4,017 14.1% of $28,541

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.