Employer

Shults Ford Lincoln, Inc.

10401 Perry Highway, Wexford, PA 15090 · EIN 25-1803084 · Jul 1, 2024 to Jun 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 $92,577

Coverage	Carrier	Broker	Lives	Direct comp
Medical	Highmark, Inc.	Seubert & Associates, Inc.	202	$30,408 3.0% of $1,026,327
Dental	Highmark, Inc.	Seubert & Associates Inc.	244	$6,228 9.9% of $62,779
Vision	Highmark, Inc.	Seubert & Associates Inc.	232	$1,002 4.0% of $25,256
Life	United Of Omaha Life Insurance Company	Seubert & Associates, Inc.	328	$1,754 12.7% of $13,839
Life	United Of Omaha Life Insurance Company	Professional Group Plans, Inc.	328	$692 5.0% of $13,839
Life	United Of Omaha Life Insurance Company	Seubert & Associates, Inc.	125	$7,494 13.2% of $56,655
Life	United Of Omaha Life Insurance Company	Professional Group Plans, Inc.	125	$2,833 5.0% of $56,655
Other	United Of Omaha Life Insurance Company	Seubert & Associates, Inc.	92	$18,514 17.6% of $105,080
Other	United Of Omaha Life Insurance Company	Professional Group Plans, Inc.	92	$5,254 5.0% of $105,080
Accident	United Of Omaha Life Insurance Company	Seubert & Associates, Inc.	108	$3,192 18.1% of $17,666
Accident	United Of Omaha Life Insurance Company	Professional Group Plans, Inc.	108	$883 5.0% of $17,666
Critical Illness	United Of Omaha Life Insurance Company	Seubert & Associates, Inc.	73	$4,829 17.9% of $26,908
Critical Illness	United Of Omaha Life Insurance Company	Professional Group Plans, Inc.	73	$1,345 5.0% of $26,908
Other	Highmark, Inc.	Seubert & Associates, Inc.	173	$8,149 3.0% of $274,586

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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