Employer

Patriot Home Care, Inc.

5700 N Broad Street, Ste 3, Philadelphia, PA 19141 · EIN 45-5564096 · Jan 1, 2020 to Dec 31, 2020

Plan year 2020

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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 $141,626

Coverage	Carrier	Broker	Lives	Direct comp
Stop-loss	Westport Insurance Corporation	—	2024	Comp not disclosed Premium $434,226
Medical	Madison National Life	Navigation Benefits LLC	178	$25,416 18.1% of $140,729
Medical	Madison National Life	Mgu Underwriting Fee	178	$7,740 5.5% of $140,729
Dental + Vision	Ameritas Life Insurance	Mitchell Henry Besvinick	891	$23,871 10.7% of $222,305
Dental + Vision	Ameritas Life Insurance	Navigation Benefits LLC	891	$21,008 9.5% of $222,305
Dental + Vision	Ameritas Life Insurance	Winkelman Iii, Robert B	891	$3,559 1.6% of $222,305
Life	Sun Life Assurance Company Of Ca	Navigation Benefits LLC	2556	$21,781 15.0% of $145,209
Legal	Arag Insurance Company	Michael J Sweeney	118	$1,145 10.0% of $11,445
Other	Continental American Insurance Company	Navigation Benefits LLC	420	$27,286 27.4% of $99,468
Other	Continental American Insurance Company	Robert B. Winkelman Iii	420	$3,673 3.7% of $99,468
Other	Sun Life Assurance Company Of Ca	Navigation Benefits LLC	162	$6,147 20.0% of $30,734

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 $1,105,619

Party	Type	Amount	$ / Enrolled / Year
The Loomis Company	Recordkeeper	$302,897	$118.50
Ameritas	Recordkeeper	$202,820	$79.35
Navigation Benefits LLC	Recordkeeper	$159,428	$62.37
Robert Winkelman Iii	Recordkeeper	$155,541	$60.85
Mgu Underwriting Fee	Recordkeeper	$152,703	$59.74
First Health Group Corp	Recordkeeper	$132,230	$51.73

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