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Employer
1818 Market Street, Philadelphia, PA 19103 · EIN 82-4688610 · Jan 1, 2024 to Dec 31, 2024
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 $56,417
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Aetna Life Insurance Company | Assured Partners (Central Pa) | 387 | $14,320 0.2% of $7,490,910 |
| Vision | Vision Service Plan | — | 317 | Comp not disclosed Premium $59,585 |
| Life | Hartford Life And Accident | Assured Partners (Central Pa) | 399 | $31,296 7.1% of $441,343 |
| Group Whole Life | Bankers Fidelity Life Insurance Company | Assured Partners (Central Pa) | 49 | $7,142 38.5% of $18,572 |
| Legal Services Plan Memberships | Pre-Paid Legal Services Inc DBA Legalshield | Mary Theresa Fisher | 72 | $3,387 19.2% of $17,640 |
| Legal Services Plan Memberships | Pre-Paid Legal Services Inc DBA Legalshield | Assured Partners (Central Pa) | 72 | $174 1.0% of $17,640 |
| Legal Services Plan Memberships | Pre-Paid Legal Services Inc DBA Legalshield | Mercer Health & Benefits, LLC | 72 | $54 0.3% of $17,640 |
| Legal Services Plan Memberships | Pre-Paid Legal Services Inc DBA Legalshield | John J Halpin | 72 | $44 0.2% of $17,640 |
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 $126,762
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Lyra Health, Inc | Worklife Services | $94,776 | $237.53 |
| The Hartford | Std Aso/Leave Mgmt/Fmla | $31,986 | $80.17 |