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Employer
161 Washington St, Ste 1111, Conshohocken, PA 19428 · EIN 23-0952300 · Jan 1, 2025 to Dec 31, 2025
Plan year 2025
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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 $254,423
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Metropolitan Life Insurance Company | Pentra LLC | 495 | $9,224 13.9% of $66,533 |
| Medical | Metropolitan Life Insurance Company | Mercer (Us), Inc. | 495 | $6,437 9.7% of $66,533 |
| Medical | Metropolitan Life Insurance Company | Mercer (Us), Inc. | 495 | $557 0.8% of $66,533 |
| Medical | Metropolitan Life Insurance Company | Mercer (Us), Inc. | 491 | $13,599 22.4% of $60,600 |
| Medical | Metropolitan Life Insurance Company | Mercer (Us), Inc. | 491 | $1,182 2.0% of $60,600 |
| Vision | Eyemed Vision Care On Behalf Of The Combined Insurance Co Of America | Pentra LLC | 1554 | $21,172 17.7% of $119,521 |
| Vision | Eyemed Vision Care On Behalf Of The Combined Insurance Co Of America | Mercer Health & Benefits, LLC | 1554 | $5,486 4.6% of $119,521 |
| Life | Penn Mutual Life Insurance Company | — | 1397 | Comp not disclosed Premium $872,943 |
| Life | Penn Mutual Life Insurance Company | — | 62 | Comp not disclosed Premium $64,039 |
| Other | Life Insurance Company Of North America | Pentra LLC | 1052 | $25,591 6.4% of $400,055 |
| Other | Life Insurance Company Of North America | Mercer (Us), Inc. | 1052 | $22,637 5.7% of $400,055 |
| Other | Life Insurance Company Of North America | American Insurance Administrators | 1052 | $3,698 0.9% of $400,055 |
| Statutory Disability | New York Life Group Insurance Co. Of New York | Pentra LLC | 29 | $798 9.5% of $8,404 |
| Statutory Disability | New York Life Group Insurance Co. Of New York | American Insurance Administrators | 29 | $168 2.0% of $8,404 |
| Statutory Disability | New York Life Group Insurance Co. Of New York | Mercer (Us), Inc. | 29 | $42 0.5% of $8,404 |
| Other | Life Insurance Company Of North America | Pentra LLC | — | $1,103 10.5% of $10,508 |
| Other | Eyemed Vision Care On Behalf Of The Combined Insurance Co Of America | Mercer Health & Benefits, LLC | 87 | $194 4.0% of $4,801 |
| Medical | Transamerica Life Insurance Company Medicare Supplement | Amwins Group Benefits LLC | 163 | $71,811 16.2% of $442,961 |
| Medical | Transamerica Life Insurance Company Medicare Supplement | Web Tpa | 163 | $14,329 3.2% of $442,961 |
| Medical | Transamerica Life Insurance Company Medicare Supplement | Mercer Health & Benefit Insurance S | 163 | $6,132 1.4% of $442,961 |
| Medical | Transamerica Life Insurance Company Medicare Supplement | Pentra, Inc. | 163 | $4,722 1.1% of $442,961 |
| Medical | Companion Life Insurance Company - Columbia | Amwins Group Benefits LLC | 162 | $15,015 12.8% of $117,209 |
| Medical | Companion Life Insurance Company - Columbia | Mercer Health & Benefit Insurance S | 162 | $1,831 1.6% of $117,209 |
| Medical | Companion Life Insurance Company - Columbia | Pentra, Inc. | 162 | $1,407 1.2% of $117,209 |
| Medical | Elixir | Amwins Group Benefits LLC | 162 | $21,293 6.6% of $323,376 |
| Medical | Elixir | Mercer Health & Benefit Insurance S | 162 | $3,632 1.1% of $323,376 |
| Medical | Elixir | Pentra, Inc. | 162 | $2,363 0.7% of $323,376 |
| Accidental Death & Dismemberment | Penn Mutual Life Insurance Company | — | 1051 | Comp not disclosed |
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 $1,340,466
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Cigna Health And Life Insurance Com | Claims Administrator | $1,026,292 | $508.32 |
| Lyra Health, Inc. | Contract Administrator | $187,903 | $93.07 |
| Delta Dental Of Pennsylvania | Contract Administrator | $97,568 | $48.32 |
| Health Advocate Solutions Inc. | Contract Administrator | $18,468 | $9.15 |
| Amwins | Third Party Adminstrator | $10,235 | $54.73 |