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Employer
1500 Spring Garden Street, Philadelphia, PA 19130 · EIN 23-1657763 · Jan 1, 2022 to Dec 31, 2022
Plan year 2022
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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 $20,838
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Independence Blue Cross | — | 110 | Comp not disclosed Premium $907,462 |
| Dental | Metropolitan Life Insurance Company | Usi Ins Services LLC | 130 | $5,474 11.1% of $49,276 |
| Vision | Eyemed Vision Care | Usi Insurance Services (Ri) | 100 | $577 10.5% of $5,515 |
| Life | The Lincoln National Life Insurance Company | Usi Insurance Services (Ri) | 85 | $5,504 19.4% of $28,354 |
| Life | The Lincoln National Life Insurance Company | Acrisusre LLC | 85 | $503 1.8% of $28,354 |
| AD&D | The Lincoln National Life Insurance Company | Usi Insurance Services (Ri) | 61 | $2,069 19.0% of $10,891 |
| AD&D | The Lincoln National Life Insurance Company | Acrisusre LLC | 61 | $208 1.9% of $10,891 |
| Other | The Lincoln National Life Insurance Company | Usi Insurance Services (Ri) | 67 | $3,541 19.8% of $17,895 |
| Other | The Lincoln National Life Insurance Company | Acrisusre LLC | 67 | $295 1.6% of $17,895 |
| Other | The Lincoln National Life Insurance Company | Usi Insurance Services (Ri) | 85 | $2,346 19.0% of $12,376 |
| Other | The Lincoln National Life Insurance Company | Acrisure, LLC DBA Ashton Benefits | 85 | $321 2.6% of $12,376 |
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.
No Schedule C parties in this year.