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Employer
5000 Paschall Avenue, Philadelphia, PA 19143 · EIN 23-0716790 · Jul 1, 2024 to Jun 30, 2025
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 $11,866
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Everest Reinsurance Company | — | — | Comp not disclosed Premium $379 |
| Stop-loss | Fair American Insurance And Reinsurance Company | — | 136 | Comp not disclosed Premium $438,212 |
| Dental | Metropolitan Life Insurance Company | Corporate Synergies Group, LLC | 140 | $1,869 3.5% of $53,765 |
| Dental | Metropolitan Life Insurance Company | Centro Benefits Research LLC | 140 | $1,854 3.4% of $53,765 |
| Dental | Metropolitan Life Insurance Company | Corporate Synergies Group, LLC | 140 | $1,334 2.5% of $53,765 |
| Dental | Metropolitan Life Insurance Company | Cbiz Benefits & Ins. Services | 140 | $914 1.7% of $53,765 |
| Vision | National Vision Administrators, LLC | Corporate Synergies Group, LLC | 111 | $513 6.6% of $7,722 |
| Vision | National Vision Administrators, LLC | Cbiz Benefits & Ins. Services | 111 | $259 3.4% of $7,722 |
| Life | United Of Omaha Life Insurance Company | Corporate Synergies Group, LLC | 153 | $383 11.1% of $3,437 |
| Life | United Of Omaha Life Insurance Company | Cbiz Benefits & Ins. Services | 153 | $62 1.8% of $3,437 |
| AD&D | United Of Omaha Life Insurance Company | Corporate Synergies Group, LLC | 28 | $1,236 11.1% of $11,109 |
| AD&D | United Of Omaha Life Insurance Company | Cbiz Benefits & Ins. Services | 28 | $204 1.8% of $11,109 |
| Other | United Of Omaha Life Insurance Company | Corporate Synergies Group, LLC | 153 | $1,989 16.8% of $11,813 |
| Other | United Of Omaha Life Insurance Company | Cbiz Benefits & Ins. Services | 153 | $426 3.6% of $11,813 |
| Other | United Of Omaha Life Insurance Company | Corporate Synergies Group, LLC | 153 | $823 5.4% of $15,208 |
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 $87,291
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Corporate Synergies Group, LLC | Broker | $40,359 | $253.83 |
| The Benecon Group, LLC | Broker | $33,917 | $213.31 |
| Meritain Health, An Aetna Company | Admin | $13,015 | $81.86 |