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Employer
3866 N.Providence Rd, Newtown Square, PA 19028 · EIN 23-1706447 · 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 $19,902
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Sun Life Assurance Company | — | 85 | Comp not disclosed Premium $386,517 |
| Dental | The Guardian Life Insurance Company Of America | James R Nelligan & Associates | 89 | $10,860 12.9% of $83,964 |
| Vision | Vision Service Plan | Rsc Insurance Brokerage, Inc. | 79 | $961 6.4% of $14,921 |
| Vision | Vision Service Plan | Employee Navigator, LLC | 79 | $38 0.3% of $14,921 |
| Life | United Of Omaha Life Insurance Company | Fairmount Benefits, Inc. | 115 | $402 13.0% of $3,095 |
| Vol Short Term Disability | United Of Omaha Life Insurance Company | Fairmount Benefits, Inc. | 55 | $1,822 13.0% of $14,017 |
| Vol Long Term Disability | United Of Omaha Life Insurance Company | Fairmount Benefits, Inc. | 49 | $3,593 13.0% of $27,636 |
| Term Life - Voluntary | United Of Omaha Life Insurance Company | Fairmount Benefits, Inc. | 54 | $2,226 13.0% of $17,118 |
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 $86,870
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Fairmount Benefits Inc. | Broker | $42,148 | $458.13 |
| The Benecon Group | Broker | $26,265 | $285.49 |
| Independence Administrators (Ia) | Admin | $18,457 | $200.62 |