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Employer
1100 Powell Street, Norristown, PA 19401 · EIN 23-1548819 · 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 $57,650
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Independence Blue Cross | Flexible Benefit Plans, LLC | 103 | $43,316 7.2% of $605,774 |
| Medical | Reliance Standard Life Insurance Company | Pentra, LLC | 20 | $583 17.1% of $3,405 |
| Medical | Reliance Standard Life Insurance Company | American Insurance Administrators | 20 | $40 1.2% of $3,405 |
| Medical | Reliance Standard Life Insurance Company | Pentra, LLC | 15 | $334 17.6% of $1,893 |
| Medical | Reliance Standard Life Insurance Company | American Insurance Administrators | 15 | $28 1.5% of $1,893 |
| Dental | Delta Dental Of Pennsylvania | Pentra LLC | 117 | $2,207 5.0% of $44,134 |
| Vision | Fidelity Security Life Insurance Company | Pentra, LLC | 108 | $1,710 21.3% of $8,045 |
| Vision | Fidelity Security Life Insurance Company | Pentra, LLC | 108 | $1,710 21.3% of $8,045 |
| Vision | Fidelity Security Life Insurance Company | Pentra, LLC | 3 | $24 10.1% of $238 |
| Vision | Fidelity Security Life Insurance Company | Pentra, LLC | 3 | $24 10.1% of $238 |
| Life | Reliance Standard Life Insurance Company | Pentra, LLC | 106 | $1,704 17.7% of $9,640 |
| Life | Reliance Standard Life Insurance Company | American Insurance Administrators | 106 | $143 1.5% of $9,640 |
| Life | Reliance Standard Life Insurance Company | Pentra, LLC | 34 | $872 19.0% of $4,587 |
| Life | Reliance Standard Life Insurance Company | American Insurance Administrators | 34 | $73 1.6% of $4,587 |
| Other | Independence Blue Cross | — | 103 | Comp not disclosed Premium $206,127 |
| Other | Reliance Standard Life Insurance Company | Pentra, LLC | 62 | $2,310 17.7% of $13,044 |
| Other | Reliance Standard Life Insurance Company | American Insurance Administrators | 62 | $196 1.5% of $13,044 |
| (Voluntary) | Reliance Standard Life Insurance Company | Pentra, LLC | 5 | $315 15.7% of $2,005 |
| (Voluntary) | Reliance Standard Life Insurance Company | American Insurance Administrators | 5 | $46 2.3% of $2,005 |
| Other | Reliance Standard Life Insurance Company | Pentra, LLC | 67 | $1,852 17.8% of $10,386 |
| Other | Reliance Standard Life Insurance Company | American Insurance Administrators | 67 | $163 1.6% of $10,386 |
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.