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Employer
615 Chestnut Street, Philadelphia, PA 19106 · EIN 23-6251648 · 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 $40,186
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Sun Life Assurance Company | — | 231 | Comp not disclosed Premium $989,159 |
| Dental | Guardian Life Insurance Company | Risk Placement Services Inc | 237 | $16,237 11.2% of $145,126 |
| Dental | Guardian Life Insurance Company | Ameriheath Administors, Inc | 237 | $9 0.0% of $145,126 |
| Life | United Of Omaha Life Insurance Company | Patriot Growth Insurance Svcs LLC | 257 | $6,293 10.0% of $62,933 |
| AD&D | United Of Omaha Life Insurance Company | Patriot Growth Insurance Svcs LLC | 107 | $4,190 10.0% of $41,899 |
| EAP | Main Line Health | — | 200 | Schedule A not provided |
| Other | United Of Omaha Life Insurance Company | Patriot Growth Insurance Svcs LLC | 257 | $5,761 10.0% of $57,614 |
| Other | United Of Omaha Life Insurance Company | Patriot Growth Insurance Svcs LLC | 257 | $7,696 10.0% of $76,961 |
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.
Visible subtotal $256,578
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Patriot (Exude, Inc.) | Broker | $159,036 | $618.82 |
| The Benecon Group, LLC | Broker | $58,103 | $226.08 |
| Independence Administrators | Admin | $39,439 | $153.46 |