Employer

Evolution Medical Communications

One Liberty Place, Philadelphia, PA 19103 · EIN 01-0842935 · Dec 1, 2021 to Nov 30, 2022

Plan year 2021

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Schedule A

Direct compensation

Coverage contracts on the filing. If the carrier did not provide Schedule A, the row is listed with that note.

Visible subtotal $25,197

Coverage	Carrier	Broker	Lives	Direct comp
Medical	Aetna Life Insurance Company	Kistler Tiffany Benefits Co	189	$3,462 0.3% of $1,237,211
Dental	Aetna Life Insurance Co	Assured Partners (Central Pa)	207	$4,848 8.8% of $55,400
Dental	Aetna Life Insurance Co	Kistler Tiffany Benefits Co	207	$1,532 2.8% of $55,400
Life	The Lincoln National Life Insurance Company	Assured Partners (Central Pa)	117	$1,022 15.0% of $6,810
Life	The Lincoln National Life Insurance Company	Assured Partners (Central Pa)	117	$239 3.5% of $6,810
AD&D	The Lincoln National Life Insurance Company	Assured Partners (Central Pa)	32	$974 15.0% of $6,493
AD&D	The Lincoln National Life Insurance Company	Assured Partners (Central Pa)	32	$925 14.2% of $6,493
Accident, Critical Illness, Hospital Indemnity	Hartford Life And Accident	Assured Partners (Central Pa)	12	$2,971 27.2% of $10,915
Other	The Lincoln National Life Insurance Company	Assured Partners (Central Pa)	117	$3,637 15.0% of $24,247
Other	The Lincoln National Life Insurance Company	Assured Partners (Central Pa)	117	$787 3.2% of $24,247
Other	The Lincoln National Life Insurance Company	Assured Partners (Central Pa)	117	$3,942 15.0% of $26,278
Other	The Lincoln National Life Insurance Company	Assured Partners (Central Pa)	117	$858 3.3% of $26,278

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 $8,638

Party	Type	Amount	$ / Enrolled / Year
Human Resources Administrator	Hra/Fsa Admin	$8,638	$24.54

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