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Employer
67 Seal Rd, Eighty Four, PA 15330 · EIN 55-0585587 · Jan 1, 2025 to Jul 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 $40,750
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Highmark, Inc. | Aaron Daniel Gander | 123 | $29,040 2.0% of $1,470,576 |
| Dental | Metropolitan Life Insurance Company | Stalwart Insurance LLC | 121 | $3,092 4.3% of $71,971 |
| Dental | Metropolitan Life Insurance Company | Stalwart Insurance LLC | 122 | $15 0.2% of $6,373 |
| Vision | Fsl | Stalwart Insurance LLC | 100 | $872 8.0% of $10,895 |
| Life | Reliance Standard Life Insurance Company | Stalwart Insurance LLC | 38 | $1,042 10.7% of $9,715 |
| Life | Reliance Standard Life Insurance Company | Lr Webber | 38 | Comp not disclosed Premium $9,715 |
| Life | Reliance Standard Life Insurance Company | Stalwart Insurance LLC | 39 | $917 16.8% of $5,458 |
| Life | Reliance Standard Life Insurance Company | Lr Webber | 39 | Comp not disclosed Premium $5,458 |
| Other | Reliance Standard | Stalwart Insurance LLC | 38 | $1,298 11.0% of $11,798 |
| Other | Reliance Standard | Lr Webber | 38 | Comp not disclosed Premium $11,798 |
| Other | Reliance Standard | Stalwart Insurance LLC | 37 | $1,899 15.0% of $12,663 |
| Other | Reliance Standard | Lr Webber | 37 | Comp not disclosed Premium $12,663 |
| Other | Reliance Standard Life Insurance Company | Stalwart Insurance LLC | 39 | $1,103 16.9% of $6,513 |
| Other | Reliance Standard Life Insurance Company | Lr Webber | 39 | Comp not disclosed Premium $6,513 |
| Other | Reliance Standard Life Insurance Company | Stalwart Insurance LLC | 39 | $1,472 20.9% of $7,051 |
| Other | Reliance Standard Life Insurance Company | Lr Webber | 39 | Comp not disclosed Premium $7,051 |
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.