Form 5500 · Employee benefit plan · KINGSLEY, PA
DIAZ STONE AND PALLET, INC.
DIAZ STONE AND PALLET, INC. of KINGSLEY, PA insures dental, vision, life, disability and stop-loss coverage for its employees, per Schedule A of its Form 5500. Its broker of record is CUMMINGS INSURANCE AGENCY INC. Coverage is written through FAIR AMERICAN INSURANCE AND REINSURANCE COMPANY and 2 other carriers. The plan's most recent policy period ended in March.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 20-0514441 · plan 501 · as of Aug 2026
Plan brief
Schedule A lists 3 insured contracts covering dental, vision, life, disability and stop-loss; the largest, with FAIR AMERICAN INSURANCE AND REINSURANCE COMPANY, covers 74 people.
The only insured piece of the health benefit is stop-loss coverage — the plan itself is self-funded, so premium and commission here reflect the stop-loss contract, not medical premium.
Reported premium across the insured contracts is $341,649, with $13,819 in disclosed broker commissions — about 4% of premium.
The most recent policy period ended in March, and the plan year ends March 31. Group contracts typically renew on that annual cycle.
CUMMINGS INSURANCE AGENCY INC is the broker of record on 1 of the 3 contracts; the rest name a different broker or none.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | Dental, Vision, Life, Disability | 85 | March | $124,904 | $13,819 |
| OPTUM HEALTH (UNIMERICA INSURANCE COMPANY) | Stop-loss | 97 | June | $53,155 | $0 |
| FAIR AMERICAN INSURANCE AND REINSURANCE COMPANY | Stop-loss | 74 | March | $163,590 | $0 |
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