Employer

Board Of Trustees Of Teamsters Local 830 Welfare Fund

12298 Townsend Road, Philadelphia, PA 19154 · EIN 23-1415471 · Sep 1, 2024 to Aug 31, 2025

Plan year 2024

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Schedule A

Direct compensation

Coverage contracts on the filing. If the carrier did not provide Schedule A, the row is listed with that note.

Visible subtotal $113,525

Coverage	Carrier	Broker	Lives	Direct comp
Stop-loss	Sun Life Assurance Company Of Canada	Stealth Partner Group LLC	1985	$47,115 5.0% of $942,303
Stop-loss	Sun Life Assurance Company Of Canada	Robert Bergman	1985	$32,981 3.5% of $942,303
Dental	United Concordia Dental Plans Of Pennsylvania Inc	—	40	Comp not disclosed Premium $8,418
Life	Metropolitan Life Insurance Company	Franklin Employee Benefits Consulti	1757	$29,090 10.7% of $271,103
Life	Metropolitan Life Insurance Company	Triben Insurance Solutions Inc	1757	$4,339 1.6% of $271,103

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 $3,532,567

Party	Type	Amount	$ / Enrolled / Year
Keystone Health Plan East	None	$1,416,890	$659.02
Spear Wilderman, P.C.	None	$336,000	$156.28
Temple University Hospital	None	$284,167	$132.17
Express Scripts Inc.	None	$260,296	$121.07
Samuel J. Kenish	Employee	$145,082	$67.48
Mental Health Consultants, Inc.	None	$106,128	$49.36
United Concordia Companies, Inc.	None	$82,165	$38.22
Novak Francella LLC	None	$67,779	$31.53
Jennifer Schmeltzer	Employee	$66,907	$31.12
Brandon Kenish	Employee	$58,768	$27.33
Louis P. Mattucci & Associates	None	$58,650	$27.28
Agnes Breen	Employee	$58,107	$27.03
Mary C. Joniec	Employee	$55,812	$25.96
Patricia Perrone	Employee	$46,301	$21.54
Gabriel Del Gaiso	Employee	$45,799	$21.30
Jennifer Langdon	Employee	$44,829	$20.85
Summit Actuarial Services LLC	None	$39,800	$18.51
Kassidy Rusden	Employee	$38,807	$18.05
Patricia Austin	Employee	$37,152	$17.28
Loomis Sayles & Company Lp	None	$36,969	$17.19
Amalgamated Bank Of Chicago	None	$35,863	$16.68
Eleanor Riley	Employee	$31,740	$14.76
Cleary, Josem & Trigliani LLP	None	$29,388	$13.67
Benecard Services Inc	None	$27,791	$12.93
Cozen O'Connor	None	$26,993	$12.55
Investment Performance Services	None	$25,000	$11.63
Pharmacy Consulting Solutions	None	$22,301	$10.37
National Vision Administrators	None	$11,516	$5.36
Aristotle Pacific Capital LLC	None	$10,892	$5.07
Healthsmart Rx Solutions	None	$9,461	$4.40
Principal Financial Group, Inc.	None	$8,764	$4.08
Cancer Study Group LLC	None	$6,450	$3.00
Boyd Watterson Asset Management	None	Comp not disclosed	—
Watchkeep	None	Comp not disclosed	—
Trust Benefit Technologies	None	Comp not disclosed	—

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