Employer
Forms And Surfaces Inc
1901 William Flynn Highway, Glenshaw, PA 15116 · EIN 25-1476717 · Jan 1, 2025 to Dec 31, 2025
Plan year 2025
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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 $827
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Highmark Inc. | — | 507 | Comp not disclosed Premium $27,225 |
| Dental | Delta Dental Of Pennsylvania | — | 532 | Comp not disclosed Premium $126,903 |
| Life | Hartford Life And Accident | Edgewood Partners Insurance Center | 488 | $827 0.3% of $253,573 |
Schedule C
Additional compensation
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.