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Employer
1301 North 31st Street, Philadelphia, PA 19121 · EIN 88-0521680 · Jan 1, 2024 to Dec 31, 2024
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 $71,038
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Dental | The Guardian Life Insurance Company Of America | James R Nelligan & Associates | 534 | $35,398 5.9% of $603,941 |
| Dental | The Guardian Life Insurance Company Of America | Rsc Insurance Brokerage, Inc. | 534 | $23,072 3.8% of $603,941 |
| Dental | The Guardian Life Insurance Company Of America | Amerihealth Administrators, Inc. | 534 | $7,958 1.3% of $603,941 |
| Vision | Vision Service Plan | Rsc Insurance Brokerage, Inc. | 356 | $1,371 5.7% of $24,091 |
| Vision | Vision Service Plan | Fairmount Benefits, Inc. | 356 | $180 0.7% of $24,091 |
| Attained Age Critical Illness | Unum Life Insurance Company | Rsc Insurance Brokerage, Inc. | 35 | $1,795 15.3% of $11,722 |
| Group Accident | Unum Insurance Company | — | 67 | Comp not disclosed Premium $11,389 |
| Hospital Ee Paid | Unum Insurance Company | Rcs Insurance Brokerage, Inc | 39 | $1,264 15.1% of $8,385 |
| Stop-loss | HM Life Insurance Company | — | — | Comp not disclosed Premium $864 |
| Stop-loss | Sun Life Assurance Company | — | 376 | Comp not disclosed Premium $854,908 |
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 $240,387
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Fairmount Benefits, Inc. | Broker | $118,179 | $314.31 |
| The Benecon Group, LLC | Broker | $57,253 | $152.27 |
| Independant Admnistrators (Ia) | Admin | $45,083 | $119.90 |
| ConnectCare3 | Patient Advocate | $19,872 | $52.85 |