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Employer
426 W. Lancaster Avenue, Devon, PA 19333 · EIN 23-2328680 · Jan 1, 2022 to Dec 31, 2022
Plan year 2022
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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 $72,984
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Metropolitan Life Insurance Company | Acrisure LLC DBA The Whitmore Agy | 220 | $1,472 4.4% of $33,117 |
| Medical | Metropolitan Life Insurance Company | Whitmore Group Ltd | 220 | $790 2.4% of $33,117 |
| Medical | Metropolitan Life Insurance Company | Modi Financial, LLC | 220 | $109 0.3% of $33,117 |
| Medical | Metropolitan Life Insurance Company | Modi Financial, LLC | 149 | $4,601 11.8% of $39,025 |
| Medical | Independence Blue Cross | Modi Financial, LLC | 427 | Comp not disclosed Premium $3,394,029 |
| Dental + Vision | Metropolitan Life Insurance Company | Acrisure LLC DBA Garceau Ins Agny | 577 | $1,452 0.4% of $342,728 |
| Dental + Vision | Metropolitan Life Insurance Company | Modi Financial, LLC | 577 | $38,165 11.1% of $342,728 |
| Life | Metropolitan Life Insurance Company | Acrisure LLC DBA The Whitmore Agy | 932 | $15,616 4.9% of $318,860 |
| Life | Metropolitan Life Insurance Company | Whitmore Group Ltd | 932 | $7,424 2.3% of $318,860 |
| Critical Illness | Metropolitan Life Insurance Company | Whitmore Group Ltd | 79 | $1,458 3.6% of $40,363 |
| Critical Illness | Metropolitan Life Insurance Company | Acrisure LLC DBA The Whitmore Agy | 79 | $1,398 3.5% of $40,363 |
| Critical Illness | Metropolitan Life Insurance Company | Modi Financial, LLC | 79 | $499 1.2% of $40,363 |
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.