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Employer
30 S 17th St Fl 6, Philadelphia, PA 19103 · EIN 23-1392502 · 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 $207,703
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Amerihealth Insurance Company | — | 15 | Comp not disclosed Premium $123,187 |
| Medical | Independence Blue Cross | — | 245 | Comp not disclosed Premium $2,298,435 |
| Medical | Independence Blue Cross | — | 1671 | Comp not disclosed Premium $15,141,572 |
| Medical | Kaiser Foundation Health Plan Inc | — | 43 | Comp not disclosed Premium $504,940 |
| Medical | Kaiser Foundation Health Plan Inc | — | 35 | Comp not disclosed Premium $317,054 |
| Dental | Delta Dental | — | 2163 | Comp not disclosed Premium $989,450 |
| Vision | Vision Service Plan | — | 947 | Comp not disclosed Premium $142,333 |
| Life | Metropolitan Life Insurance Company | Patriot Growth Ince Services LLC | 1879 | $40,665 6.2% of $652,083 |
| Life | Metropolitan Life Insurance Company | James R Nelligan & Associates | 1879 | $32,517 5.0% of $652,083 |
| Life | Metropolitan Life Insurance Company | Safegard Group Inc | 98 | $51,325 9.1% of $561,854 |
| Accidental Death & Dismemberment | National Union Fire Ins. Co. Of Pittsburgh, Pa | Aon Consulting, Inc. | — | $992 20.0% of $4,958 |
| Other | Unum Life Insurance Company Of America | Pentra, LLC | 1437 | $82,204 5.3% of $1,543,602 |
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 $8,166,176
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Wex Health Ince | Third Party | $29,549 | $77.56 |
| Cvs Pharmacy, Inc | Contract Administrator | $8,136,627 | $3,761.73 |