Employer
Fairmount Long Term Care
2100 West Girard Avenue, Philadelphia, PA 19130 · EIN 23-2746587 · Jul 1, 2021 to Jun 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 $77,751
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Independence Blue Cross | Emerson Reid DBA Tra Benefit | 1 | $12,057 109.0% of $11,057 |
| Medical | Keystone | Emerson Reid DBA Tra Benefit | 23 | $62,102 2.8% of $2,202,935 |
| Dental | Aetna | Beneserv, A Division Of Onedigital | 220 | $3,592 5.0% of $71,652 |
Schedule C
Additional compensation
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.