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Employer
42751 Route 6, Wyalusing, PA 18853 · EIN 90-0920357 · 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 $19,204
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | — | Comp not disclosed Premium $94,184 |
| Dental + Vision | The Guardian Life Insurance Company Of America | Cummings Insurance Agency | 50 | $2,502 8.1% of $30,751 |
| Dental + Vision | The Guardian Life Insurance Company Of America | Emerson Rogers LLC | 50 | $1,506 4.9% of $30,751 |
| Dental + Vision | The Guardian Life Insurance Company Of America | Mazzmar LLC | 50 | $8 0.0% of $30,751 |
| Dental + Vision | The Guardian Life Insurance Company Of America | Independence Planning Group | 50 | $7 0.0% of $30,751 |
| Life | The Lincoln National Life Insurance Company | Keystone Ins. & Benefits Grp LLC | 75 | $1,708 21.3% of $8,027 |
| Life | The Lincoln National Life Insurance Company | Emerson Rogers LLC | 75 | $755 9.4% of $8,027 |
| Life | American Heritage Life Insurance Company | Schultz Stephen Gerard | 6 | $1,171 28.0% of $4,184 |
| Life | American Heritage Life Insurance Company | Ideal Benefits Group | 6 | $75 1.8% of $4,184 |
| Life | American Heritage Life Insurance Company | Labow Howard B | 6 | $20 0.5% of $4,184 |
| Vol. Std, Accident, Critical Illness, Hospital Indemnity, Vol. Life | Aflac | Stephen G Schultz | 18 | $6,074 15.5% of $39,260 |
| Vol. Std, Accident, Critical Illness, Hospital Indemnity, Vol. Life | Aflac | Kilmer Insurance Agency Inc | 18 | $2,772 7.1% of $39,260 |
| Vol. Std, Accident, Critical Illness, Hospital Indemnity, Vol. Life | Aflac | Jeffrey Charles Chubb | 18 | $1,455 3.7% of $39,260 |
| Vol. Std, Accident, Critical Illness, Hospital Indemnity, Vol. Life | Aflac | Justin P Abraham | 18 | $711 1.8% of $39,260 |
| Vol. Std, Accident, Critical Illness, Hospital Indemnity, Vol. Life | Aflac | Joseph B Mcginty Jr | 18 | $188 0.5% of $39,260 |
| Vol. Std, Accident, Critical Illness, Hospital Indemnity, Vol. Life | Aflac | Daniel Cero | 18 | $159 0.4% of $39,260 |
| Vol. Std, Accident, Critical Illness, Hospital Indemnity, Vol. Life | Aflac | Associated Ins And Fin Svcs LLC | 18 | $75 0.2% of $39,260 |
| Vol. Std, Accident, Critical Illness, Hospital Indemnity, Vol. Life | Aflac | Barbara A Kennedy | 18 | $18 0.0% of $39,260 |
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 $4,314
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group LLC | Broker | $2,239 | $24.60 |
| Cummings Insurance Agency | Broker | $2,142 | $23.54 |
| Highmark Blue Shield (Central) | Admin | $-67 | $-0.74 |