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Employer
5698 Rising Sun Avenue, Philadelphia, PA 19120 · EIN 23-1279986 · Mar 1, 2020 to Feb 28, 2021
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 $11,503
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Principal Life Insurance Company | Advanced Benefit Concepts Of Cherry | 51 | $1,072 10.0% of $10,767 |
| Medical | Colonial Life & Accident Insurance Company | Stephen M Henss LLC | 26 | $751 3.4% of $21,962 |
| Medical | Colonial Life & Accident Insurance Company | Katz Pierz Inc | 26 | $469 2.1% of $21,962 |
| Medical | Colonial Life & Accident Insurance Company | Tanya Wishard | 26 | $246 1.1% of $21,962 |
| Medical | Colonial Life & Accident Insurance Company | Sarai Hernandez | 26 | $229 1.0% of $21,962 |
| Medical | Colonial Life & Accident Insurance Company | Cathy Good | 26 | $101 0.5% of $21,962 |
| Medical | Colonial Life & Accident Insurance Company | Cynthia P Whalen | 26 | $69 0.3% of $21,962 |
| Medical | Colonial Life & Accident Insurance Company | Ronald Oliano | 26 | $28 0.1% of $21,962 |
| Medical | Colonial Life & Accident Insurance Company | Natalie S Landro | 26 | $27 0.1% of $21,962 |
| Medical | Colonial Life & Accident Insurance Company | William E Good | 26 | $23 0.1% of $21,962 |
| Medical | Colonial Life & Accident Insurance Company | David E Hauck | 26 | $21 0.1% of $21,962 |
| Medical | Colonial Life & Accident Insurance Company | Tri State Benefit Advisors Inc | 26 | $10 0.0% of $21,962 |
| Medical | Colonial Life & Accident Insurance Company | Ima Financial Group (Pittsburgh, Pa | 26 | $7 0.0% of $21,962 |
| Medical | Colonial Life & Accident Insurance Company | Ess Nextier Insurance Services LLC | 26 | $5 0.0% of $21,962 |
| Medical | Colonial Life & Accident Insurance Company | Edward P Dougherty Inc | 26 | $2 0.0% of $21,962 |
| Medical | Colonial Life & Accident Insurance Company | Ardena L Mcvicker | 26 | $2 0.0% of $21,962 |
| Medical | Colonial Life & Accident Insurance Company | Timothy J Slater | 26 | $1 0.0% of $21,962 |
| Dental | Aetna Life Insurance Co. | Katz-Pierz Inc | 132 | $2,037 6.8% of $29,982 |
| Life | Standard Insurance Company | Advanced Benefit Concepts Of Cherry | 110 | $1,542 14.0% of $11,023 |
| Other | Standard Insurance Company | Advanced Benefit Concepts Of Cherry | 29 | $1,641 17.6% of $9,327 |
| Other | Standard Insurance Company | Advanced Benefit Concepts Of Cherry | 110 | $3,220 11.3% of $28,474 |
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.