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Employer
403 Rector St, Philadelphia, PA 19128 · EIN 23-1875249 · Mar 1, 2024 to Feb 28, 2025
Plan year 2024
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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 $51,972
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Independence Blue Cross | Kistler Tiffany Benefits Co | 82 | $5,103 2.8% of $179,961 |
| Medical | Independence Blue Cross | Risk Placement Services | 82 | $1,355 0.8% of $179,961 |
| Medical | Independence Blue Cross | Kistler Tiffany Benefits Co | 13 | $26,288 3.6% of $737,476 |
| Medical | Independence Blue Cross | Risk Placement Services | 13 | $9,857 1.3% of $737,476 |
| Dental | United Concordia Companies, Inc. | Donald C Savoy Inc | 52 | $785 2.9% of $26,871 |
| Dental | United Concordia Companies, Inc. | Kistler Tiffany Benefits Co | 52 | $688 2.6% of $26,871 |
| Dental | United Concordia Dental Plans Of Pennsylvania | Kistler Tiffany Benefits Co | 33 | $325 3.1% of $10,354 |
| Dental | United Concordia Dental Plans Of Pennsylvania | Donald C Savoy Inc | 33 | $304 2.9% of $10,354 |
| Vision | Vision Service Plan | Innovative Benefit Planning, LLC | 79 | $566 9.7% of $5,849 |
| Life | Life Insurance Company Of North America | Innovative Benefit Planning, LLC | 155 | $1,652 11.3% of $14,564 |
| AD&D | Life Insurance Company Of North America | Innovative Benefit Planning, LLC | 155 | $377 17.0% of $2,224 |
| Short Term Disability | Life Insurance Company Of North America | Innovative Benefit Planning, LLC | 155 | $2,400 9.1% of $26,387 |
| Other | Life Insurance Company Of North America | Innovative Benefit Planning, LLC | 155 | $2,272 15.6% of $14,522 |
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.