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Employer
100 Veka Drive, Fombell, PA 16123 · EIN 25-1716653 · 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 $145,432
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Legal | Metlife Legal Plans | Seubert & Associates, Inc. | — | $3,297 12.1% of $27,277 |
| Stop-loss | Reliastar Life Insurance Company | Seubert & Associates Inc. | 638 | $10,000 0.9% of $1,114,882 |
| Medical | Cigna Health And Life Insurance Company | — | 135 | Comp not disclosed Premium $18,874 |
| Life | United Of Omaha Life Insurance Company | Seubert & Associates | 881 | $15,089 6.1% of $248,588 |
| Life | United Of Omaha Life Insurance Company | Professional Group Plans, Inc. | 881 | $12,429 5.0% of $248,588 |
| Life | United Of Omaha Life Insurance Company | Seubert & Associates | 263 | $11,738 14.5% of $80,960 |
| Life | United Of Omaha Life Insurance Company | Professional Group Plans, Inc. | 263 | $4,048 5.0% of $80,960 |
| Other | United Of Omaha Life Insurance Company | Seubert & Associates | 751 | $14,952 7.1% of $211,295 |
| Other | United Of Omaha Life Insurance Company | Professional Group Plans, Inc. | 751 | $10,565 5.0% of $211,295 |
| Employee Assistance Plan | United Of Omaha Life Insurance Company | Seubert & Associates | 664 | $21,934 6.5% of $336,845 |
| Employee Assistance Plan | United Of Omaha Life Insurance Company | Professional Group Plans, Inc. | 664 | $16,842 5.0% of $336,845 |
| Accident | United Of Omaha Life Insurance Company | Seubert & Associates Inc. | 374 | $9,787 26.1% of $37,566 |
| Accident | United Of Omaha Life Insurance Company | Professional Group Plans, Inc. | 374 | $1,878 5.0% of $37,566 |
| Critical Illness | United Of Omaha Life Insurance Company | Seubert & Associates Inc. | 97 | $5,443 26.3% of $20,713 |
| Critical Illness | United Of Omaha Life Insurance Company | Professional Group Plans, Inc. | 97 | $1,036 5.0% of $20,713 |
| Hospital Indemnity | United Of Omaha Life Insurance Company | Seubert & Associates Inc. | 77 | $5,347 25.5% of $20,947 |
| Hospital Indemnity | United Of Omaha Life Insurance Company | Professional Group Plans, Inc. | 77 | $1,047 5.0% of $20,947 |
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.