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Employer
324 N. Main Street, Carbondale, PA 18407 · EIN 23-2801499 · 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 $38,490
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Dental | Delta Dental Of Pennsylvania | — | 1280 | Comp not disclosed Premium $395,490 |
| Vision | Eyemed Vision Care | — | 1288 | Comp not disclosed Premium $56,561 |
| Life | Life Insurance Company Of North America | Totalis Benefits Inc | 498 | $4,301 3.3% of $129,982 |
| Life | Life Insurance Company Of North America | Totalis Benefits Inc | 891 | $5,162 3.4% of $153,561 |
| AD&D | Life Insurance Company Of North America | Totalis Benefits Inc | 891 | $765 3.4% of $22,750 |
| Other | Life Insurance Company Of North America | Totalis Benefits Inc | 784 | $7,369 3.4% of $218,015 |
| Other | Life Insurance Company Of North America | Totalis Benefits Inc | 891 | $2,706 3.4% of $79,939 |
| Employee Assistance Program | Employee Network, Inc. | — | 720 | Comp not disclosed Premium $20,124 |
| Critical Illness & Accident | Reliastar Life Insurance Company | Nfp Corporate Services (Ny) LLC | 589 | $15,241 25.9% of $58,911 |
| Critical Illness & Accident | Reliastar Life Insurance Company | Totalis Consumer Benefit Solutions | 589 | $2,946 5.0% of $58,911 |
| Bta | Life Insurance Company Of North America | — | — | 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.
No Schedule C parties in this year.