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Employer
2000 Joshua Road, Lafayette Hill, PA 19444 · EIN 23-1547587 · Jan 1, 2020 to Dec 31, 2020
Plan year 2020
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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 $62,125
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Dental | United Concordia Insurance Company | Lockton Companies, LLC | 508 | $9,576 6.4% of $150,288 |
| Life | United Of Omaha Life Insurance Company | Lockton Companies, LLC | 414 | $6,792 18.8% of $36,174 |
| AD&D | United Of Omaha Life Insurance Company | Lockton Companies, LLC | 163 | $9,801 16.6% of $59,070 |
| Voluntary Vision | HM Life Insurance Company | Lockton Companies, LLC | 420 | $2,122 10.0% of $21,222 |
| Voluntary Ltd | United Of Omaha Life Insurance Company | Lockton Companies, LLC | 174 | $9,345 10.6% of $87,805 |
| Other | United Of Omaha Life Insurance Company | Lockton Companies, LLC | 345 | $13,005 8.4% of $154,428 |
| Other | United Of Omaha Life Insurance Company | Fmla Source Inc | 345 | $5,899 3.8% of $154,428 |
| Voluntary Accident | United Of Omaha Life Insurance Company | Lockton Companies, LLC | 114 | $5,585 25.3% of $22,114 |
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 $169,687
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Independence Administrators | Administrator | $158,405 | $311.82 |
| Interflex Payments, LLC | Contract Administrator | $11,282 | $22.21 |