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Employer
9355 Blue Grass Road, Philadelphia, PA 19114 · EIN 23-1630194 · Jan 1, 2021 to Dec 31, 2021
Plan year 2021
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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 $91,500
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Unitedhealthcare Insurance Company | Nfp Corporate Services (Pa), Inc. | 154 | $39,995 2.5% of $1,575,876 |
| Medical | Unitedhealthcare Insurance Company | Usi Insurance Services (Ri) | 154 | $28,582 1.8% of $1,575,876 |
| Medical | Unitedhealthcare Insurance Company | Emerson Reid And Company | 154 | $7,070 0.4% of $1,575,876 |
| Dental + Vision | The Lincoln National Life Insurance Company | Usi Insurance Services (Ri) | 230 | $7,197 4.9% of $147,328 |
| Dental + Vision | The Lincoln National Life Insurance Company | Nfp Corporate Services (Pa), Inc. | 230 | $5,662 3.8% of $147,328 |
| Dental + Vision | The Lincoln National Life Insurance Company | Usi Insurance Services (Ri) | 230 | $946 0.6% of $147,328 |
| Accident | The Guardian Life Insurance Company Of America | — | 35 | Schedule A not provided |
| Accident | The Guardian Life Insurance Company Of America | — | 35 | Schedule A not provided |
| Accident | The Guardian Life Insurance Company Of America | — | 35 | Schedule A not provided |
| Accident | The Guardian Life Insurance Company Of America | — | 35 | Schedule A not provided |
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.