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Employer
863 Valley View Rd., Eighty Four, PA 15330 · EIN 25-1103687 · 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 $42,538
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Highmark, Inc. | Henderson Brothers Inc. | 162 | $17,766 2.0% of $882,654 |
| Medical | Highmark, Inc. | Seubert & Associates Inc. | 162 | $14,072 1.6% of $882,654 |
| Dental | Reliance Standard Life Insurance Company | Professional Group Plans, Inc. | 226 | $1,214 2.5% of $48,542 |
| Vision | Metropolitan Life Insurance Company | — | 181 | Comp not disclosed Premium $9,252 |
| Life | Reliance Standard Life Insurance Company | Henderson Brothers Inc. | 143 | $813 2.3% of $35,178 |
| Life | Reliance Standard Life Insurance Company | Professional Group Plans, Inc. | 143 | $742 2.1% of $35,178 |
| Life | Reliance Standard Life Insurance Company | Seubert & Associates Inc. | 143 | $594 1.7% of $35,178 |
| Agb World Traveler | Aetna International | — | 5 | Comp not disclosed Premium $1,000 |
| Other | Reliance Standard Life Insurance Company | Henderson Brothers Inc. | 144 | $1,777 6.2% of $28,856 |
| Other | Reliance Standard Life Insurance Company | Seubert & Associates Inc. | 144 | $1,347 4.7% of $28,856 |
| Other | Reliance Standard Life Insurance Company | Professional Group Plans, Inc. | 144 | $614 2.1% of $28,856 |
| Other | Reliance Standard Life Insurance Company | Henderson Brothers Inc. | 143 | $1,717 5.8% of $29,723 |
| Other | Reliance Standard Life Insurance Company | Seubert & Associates Inc. | 143 | $1,255 4.2% of $29,723 |
| Other | Reliance Standard Life Insurance Company | Professional Group Plans, Inc. | 143 | $627 2.1% of $29,723 |
| Other | Highmark, Inc. | — | 146 | Comp not disclosed Premium $321,650 |
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.