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Employer
3675 Market Street, Philadelphia, PA 19104 · EIN 71-0869350 · Jan 1, 2022 to Dec 31, 2022
Plan year 2022
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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 $32,051
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Provident Life And Accident Insurance Company | Alliant Insurance Services, Inc. | 53 | $559 8.1% of $6,867 |
| Medical | Provident Life And Accident Insurance Company | Engle, Hambright & Davies, Inc. | 53 | $158 2.3% of $6,867 |
| Medical | Provident Life And Accident Insurance Company | Alliant Insurance Services, Inc. | 53 | $13 0.2% of $6,867 |
| Dental | Metropolitan Life Insurance Company | Alliant Ins Services Inc | 952 | $12,106 3.0% of $399,887 |
| Dental | Metropolitan Life Insurance Company | Alliant Ins Services | 952 | $6,177 1.5% of $399,887 |
| Vision | Heartland / Nva | — | 747 | Comp not disclosed Premium $31,585 |
| Other | Provident Life And Accident Insurance Company | Alliant Insurance Services, Inc. | 1 | $56 12.4% of $451 |
| Other | Provident Life And Accident Insurance Company | Engle, Hambright & Davies, Inc. | 1 | $11 2.4% of $451 |
| Other | Provident Life And Accident Insurance Company | Alliant Insurance Services, Inc. | 29 | $3,780 17.9% of $21,172 |
| Other | Provident Life And Accident Insurance Company | Alliant Insurance Services, Inc. | 29 | $2,423 11.4% of $21,172 |
| Other | Provident Life And Accident Insurance Company | Engle, Hambright & Davies, Inc. | 29 | $317 1.5% of $21,172 |
| Group Accident | Unum Insurance Company | Alliant Insurance Services, Inc. | 48 | $1,547 15.7% of $9,874 |
| Attained Age Critical Illness | Unum Insurance Company | Alliant Insurance Services, Inc. | 40 | $3,145 20.0% of $15,727 |
| Hospital Ee Paid | Unum Insurance Company | Alliant Insurance Services, Inc. | 42 | $1,759 20.0% of $8,788 |
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.