Employer

Modern Mushroom Farms, Inc.

Po Box 340, Avondale, PA 19311 · EIN 23-1728609 · May 1, 2024 to Apr 30, 2025

Plan year 2024

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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 $45,556

Coverage	Carrier	Broker	Lives	Direct comp
Medical	Cigna Health And Life Insurance Company	Life And Health Ins Svcs	116	$31,334 10.3% of $304,860
Medical	Cigna Health And Life Insurance Company	Emerson Rogers LLC	116	$12,415 4.1% of $304,860
Life	Reliance Standard Life Insurance Company	Life And Health Ins Svcs	114	$554 15.0% of $3,691
Other	Aflac	Federick W. Wilson Iii	13	$197 3.3% of $5,992
Other	Aflac	Life And Health Ins Svcs	13	$154 2.6% of $5,992
Other	Aflac	Michael F Randler Jr	13	$134 2.2% of $5,992
Other	Aflac	Leila Rappaport	13	$73 1.2% of $5,992
Other	Aflac	Autumn Strohmaier	13	$51 0.9% of $5,992
Other	Aflac	Albert Shust	13	$47 0.8% of $5,992
Other	Aflac	Kenna M Ulbinsky Yakal	13	$39 0.7% of $5,992
Other	Aflac	John A Pituch	13	$9 0.2% of $5,992
Other	Aflac	Brian M Leypoldt	13	$4 0.1% of $5,992
Other	Aflac	John T Capozzi	13	$1 0.0% of $5,992
Other	Aflac	Joshua M Pincus Sokoloff	13	$1 0.0% of $5,992
Accidental Death And Dismem.	Reliance Standard Life Insurance Company	Life And Health Ins Svcs	7	$15 15.3% of $98
Other	Reliance Standard Life Insurance Company	Life And Health Ins Svcs	15	$215 10.0% of $2,152
Voluntary Short Term Disability	Reliance Standard Life Insurance Company	Life And Health Ins Svcs	17	$313 15.0% of $2,087

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.

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