Employer
Lombard International
1650 Market Street, 8th Floor, Philadelphia, PA 19103 · EIN 52-0795747 · Nov 1, 2022 to Oct 31, 2023
Plan year 2022
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Schedule A
Direct compensation
Coverage contracts on the filing. If the carrier did not provide Schedule A, the row is listed with that note.
Visible subtotal $71,123
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Independence Blue Cross | — | 128 | Schedule A not provided |
| Medical | Independence Blue Cross | — | 128 | Schedule A not provided |
| Medical | Keystone | — | 66 | Schedule A not provided |
| Medical | Keystone | — | 66 | Schedule A not provided |
| Dental | Metropolitan Life Insurance Company | Lockton Companies, LLC | 275 | $2,952 2.8% of $104,195 |
| Dental | Metropolitan Life Insurance Company | Lockton Companies, LLC | 275 | $1,470 1.4% of $104,195 |
| Vision | Eyemed Vision Care On Behalf Of Fidelity Security Life Insurance Co. | Lockton Companies, LLC | 151 | $875 9.9% of $8,834 |
| Life | Sun Life Assurance Company Of Canada | Lockton Companies, LLC | 103 | $11,051 12.3% of $89,826 |
| Life | Sun Life Assurance Company Of Canada | Lockton Companies, LLC | 103 | $1,533 1.7% of $89,826 |
Schedule C
Additional compensation
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.