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Employer
2400 Market Street, Philadelphia, PA 19103 · EIN 04-3196245 · Jan 1, 2024 to Dec 31, 2024
Plan year 2024
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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 $341,085
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Kaiser Foundation Health Plan, Inc. | Gordon W St John | 91 | $15,644 2.7% of $572,803 |
| Medical | Kaiser Foundation Health Plan, Inc. | Gordon W St John | 81 | $12,433 2.7% of $455,630 |
| Medical | Cigna Health And Life Insurance Company | Pentra, LLC, An Alera Group Agency | 2302 | $11,038 10.8% of $101,801 |
| Medical | Cigna Health And Life Insurance Company | Benefit Technology Resources, LLC | 2302 | $6,666 6.5% of $101,801 |
| Medical | Cigna Health And Life Insurance Company | American Insurance Administrators | 2302 | $2,866 2.8% of $101,801 |
| Medical | Cigna Health And Life Insurance Company | Pentra, LLC, An Alera Group Agency | 1389 | $22,722 10.9% of $209,232 |
| Medical | Cigna Health And Life Insurance Company | Benefit Technology Resources, LLC | 1389 | $6,667 3.2% of $209,232 |
| Medical | Cigna Health And Life Insurance Company | American Insurance Administrators | 1389 | $5,848 2.8% of $209,232 |
| Medical | Cigna Health And Life Insurance Company | Pentra, LLC, An Alera Group Agency | 1550 | $12,981 10.8% of $119,851 |
| Medical | Cigna Health And Life Insurance Company | Benefit Technology Resources, LLC | 1550 | $6,667 5.6% of $119,851 |
| Medical | Cigna Health And Life Insurance Company | American Insurance Administrators | 1550 | $3,378 2.8% of $119,851 |
| Vision | Fidelity Security Life Insurance Company | — | 4163 | Comp not disclosed Premium $197,715 |
| Vision | Fidelity Security Life Insurance Company | — | 21 | Comp not disclosed Premium $2,175 |
| Life | Life Insurance Company Of North America | Pentra LLC | 4713 | $45,923 5.9% of $773,081 |
| Life | Life Insurance Company Of North America | Benefit Technology Resources LLC | 4713 | $24,838 3.2% of $773,081 |
| Life | Life Insurance Company Of North America | American Insurance Administrators | 4713 | $15,462 2.0% of $773,081 |
| AD&D | Life Insurance Company Of North America | Pentra LLC | 4169 | $7,296 6.3% of $115,700 |
| AD&D | Life Insurance Company Of North America | Benefit Technology Resources LLC | 4169 | $3,696 3.2% of $115,700 |
| AD&D | Life Insurance Company Of North America | American Insurance Administrators | 4169 | $2,314 2.0% of $115,700 |
| (Voluntary) | Life Insurance Company Of North America | Pentra LLC | 802 | $21,401 6.8% of $314,418 |
| (Voluntary) | Life Insurance Company Of North America | Benefit Technology Resources LLC | 802 | $10,152 3.2% of $314,418 |
| (Voluntary) | Life Insurance Company Of North America | American Insurance Administrators | 802 | $6,288 2.0% of $314,418 |
| (Core & Buy-Up) | Life Insurance Company Of North America | Pentra LLC | 3383 | $48,287 5.8% of $832,181 |
| (Core & Buy-Up) | Life Insurance Company Of North America | Benefit Technology Resources LLC | 3383 | $26,490 3.2% of $832,181 |
| (Core & Buy-Up) | Life Insurance Company Of North America | American Insurance Administrators | 3383 | $16,644 2.0% of $832,181 |
| Legal | Metlife Legal Plans | Pentra, LLC | 250 | $5,012 10.2% of $48,906 |
| Legal | Metlife Legal Plans | Kistler Tiffany Benefits Co | 250 | $285 0.6% of $48,906 |
| Legal | Metlife Legal Plans | Pentra, Inc. | 250 | $87 0.2% of $48,906 |
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.