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Employer
901 S. Bolmar St. Building 1,, West Chester, PA 19382 · EIN 46-3078820 · Jul 1, 2024 to Jun 30, 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 $320,794
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | — | Comp not disclosed Premium $571 |
| Stop-loss | Sun Life Assurance Company | — | 1270 | Comp not disclosed Premium $2,932,248 |
| Dental | Cigna Health And Life Insurance Company And Affiliates (Cigna) | Onedigital (Philadelphia) | 1263 | $95,262 9.9% of $960,283 |
| Vision | Independence Administrators | — | 1298 | Comp not disclosed |
| Life | Unum Life Insurance Company Of America | Beneserv, A Division Of Onedigital | 589 | $990 10.0% of $9,895 |
| Life | Unum Life Insurance Company Of America | Emerson Rogers LLC | 589 | $495 5.0% of $9,895 |
| Cancer | Transamerica Life Insurance Company | Triben Insurance Solutions Inc | 471 | $13,495 11.2% of $120,153 |
| Cancer | Transamerica Life Insurance Company | Kistler Tiffany Benefits Co | 471 | $6,391 5.3% of $120,153 |
| Cancer | Transamerica Life Insurance Company | Emerson Rogers LLC | 471 | $2,573 2.1% of $120,153 |
| Vol Life, New York Dbl, New Jersey Tdb, Ny And Ma Family Leave, Ma Medical Leave | The Prudential Insurance Company Of America | Triben Insurance Solutions Inc. | 946 | $106,519 8.6% of $1,240,515 |
| Vol Life, New York Dbl, New Jersey Tdb, Ny And Ma Family Leave, Ma Medical Leave | The Prudential Insurance Company Of America | Triben Insurance Solutions Inc | 946 | $47,429 3.8% of $1,240,515 |
| Vol Life, New York Dbl, New Jersey Tdb, Ny And Ma Family Leave, Ma Medical Leave | The Prudential Insurance Company Of America | Onedigital (Philadelphia) | 946 | $47,429 3.8% of $1,240,515 |
| Vol Life, New York Dbl, New Jersey Tdb, Ny And Ma Family Leave, Ma Medical Leave | The Prudential Insurance Company Of America | Img | 946 | $211 0.0% of $1,240,515 |
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 $1,275,222
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Beneserv, A Division Of Onedigital | Broker | $263,979 | $197.29 |
| The Benecon Group, LLC | Broker | $158,075 | $118.14 |
| Independence Administrators | Admin | $755,180 | $564.41 |
| ConnectCare3 | Patient Advocate | $47,500 | $35.50 |
| The Prudential Insurance Company Of | Admin | $50,488 | $38.57 |