Loading employer…
Employer
100 N. 18th Street, Philadelphia, PA 19103 · EIN 27-2896376 · Nov 1, 2024 to Oct 31, 2025
Plan year 2024
View
Schedule A
Coverage contracts on the filing. If the carrier did not provide Schedule A, the row is listed with that note.
Visible subtotal $21,188
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 146 | Comp not disclosed Premium $66,087 |
| Stop-loss | Sun Life Assurance Company | — | 127 | Comp not disclosed Premium $378,257 |
| Dental + Vision | The Guardian Life Insurance Company Of America | James R Nelligan & Associates | 119 | $11,057 16.4% of $67,452 |
| Life | United Of Omaha Life Insurance Company | Fairmount Benefits, Inc. | 148 | $794 10.0% of $7,937 |
| Life | United Of Omaha Life Insurance Company | Onedigital Premier Services LLC | 148 | $397 5.0% of $7,937 |
| AD&D | United Of Omaha Life Insurance Company | Fairmount Benefits, Inc. | 44 | $3,204 15.0% of $21,357 |
| AD&D | United Of Omaha Life Insurance Company | Onedigital Premier Services LLC | 44 | $1,068 5.0% of $21,357 |
| Voluntary Short-Term Disability | United Of Omaha Life Insurance Company | Fairmount Benefits, Inc. | 49 | $1,984 10.0% of $19,843 |
| Voluntary Short-Term Disability | United Of Omaha Life Insurance Company | Onedigital Premier Services LLC | 49 | $992 5.0% of $19,843 |
| Voluntary Long-Term Disability | United Of Omaha Life Insurance Company | Fairmount Benefits, Inc. | 38 | $1,128 10.0% of $11,277 |
| Voluntary Long-Term Disability | United Of Omaha Life Insurance Company | Onedigital Premier Services LLC | 38 | $564 5.0% of $11,277 |
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 $115,955
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Fairmount Benefits Inc. | Broker | $65,231 | $446.79 |
| The Benecon Group | Broker | $34,562 | $236.73 |
| Independence Administrators (Ia) | Admin | $16,162 | $110.70 |