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Employer
590 Division Street, Dubois, PA 15801 · EIN 25-1256812 · 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 $75,546
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Highmark Inc. | Stalwart Insurance LLC | 140 | $38,896 1.9% of $2,042,826 |
| Medical | Highmark Inc. | Lr Webber | 140 | $19,571 1.0% of $2,042,826 |
| Medical | Principal Life Insurance Company | Stalwart Insurance LLC | 106 | $1,861 3.4% of $54,067 |
| Medical | Principal Life Insurance Company | Lr Webber | 106 | $1,062 2.0% of $54,067 |
| Life | Reliance Standard Life Insurance Company | Stalwart Insurance LLC | 164 | $1,390 7.4% of $18,745 |
| Life | Reliance Standard Life Insurance Company | Leavitt Northeast Insurance, Inc. | 164 | $1,008 5.4% of $18,745 |
| Life | Reliance Standard Life Insurance Company | Stalwart Insurance LLC | 78 | $1,616 7.7% of $21,020 |
| Life | Reliance Standard Life Insurance Company | Leavitt Northeast Insurance, Inc. | 78 | $1,138 5.4% of $21,020 |
| Other | Reliance Standard Life Insurance Company | Leavitt Northeast Insurance, Inc. | 167 | $2,726 4.3% of $62,964 |
| Other | Reliance Standard Life Insurance Company | Swift Kennedy Financial Co Inc | 167 | $1,995 3.2% of $62,964 |
| Other | Reliance Standard Life Insurance Company | Stalwart Insurance LLC | 169 | $2,367 9.1% of $25,882 |
| Other | Reliance Standard Life Insurance Company | Leavitt Northeast Insurance, Inc. | 169 | $1,916 7.4% of $25,882 |
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.