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Employer
2230 E Allegheny Ave, Philadelphia, PA 19134 · EIN 82-2834865 · May 1, 2023 to Apr 30, 2024
Plan year 2023
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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 $12,749
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Dental + Vision | Ameritas Life Insurance Corp | Keith Kelley | 256 | $399 1.7% of $23,488 |
| Dental + Vision | Ameritas Life Insurance Corp | Regina A. Bell | 256 | $423 1.8% of $23,488 |
| Dental + Vision | Ameritas Life Insurance Corp | Staff Benefit Management, Inc. | 256 | $1,996 8.5% of $23,488 |
| Dental + Vision | Ameritas Life Insurance Corp | Henry Mitchell Besvinick | 256 | $1,879 8.0% of $23,488 |
| Life | Boston Mutual Life Insurance Company | — | 51 | Schedule A not provided |
| Life | Boston Mutual Life Insurance Company | — | 51 | Schedule A not provided |
| Life | Boston Mutual Life Insurance Company | — | 51 | Schedule A not provided |
| Life | Manhattan Life | Regina Bell | 24 | $300 4.8% of $6,293 |
| Life | Manhattan Life | Staff Benefit Management, Inc. | 24 | $1,084 17.2% of $6,293 |
| Life | Manhattan Life | Ketih Kelley | 24 | $284 4.5% of $6,293 |
| Life | The Guardian Life Insurance Company Of America | Regina Bell | 407 | $183 1.8% of $10,214 |
| Life | The Guardian Life Insurance Company Of America | Keith Kelley | 407 | $174 1.7% of $10,214 |
| Life | The Guardian Life Insurance Company Of America | Navigatio Benefits LLC | 407 | $664 6.5% of $10,214 |
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 $33,049
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Navigation Benefits LLC | Tpa | $33,049 | $81.20 |