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Employer
4300 Rising Sun Avenue, Philadelphia, PA 19140 · EIN 23-2536562 · 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 $10,512
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Crum & Forster | — | 52 | Comp not disclosed Premium $203,386 |
| Dental | Colonial Life & Accident Insurance Company | — | 55 | Schedule A not provided |
| Dental | Colonial Life & Accident Insurance Company | — | 55 | Schedule A not provided |
| Dental | Colonial Life & Accident Insurance Company | — | 55 | Schedule A not provided |
| Dental | Colonial Life & Accident Insurance Company | — | 55 | Schedule A not provided |
| Dental | Colonial Life & Accident Insurance Company | — | 55 | Schedule A not provided |
| Dental | Colonial Life & Accident Insurance Company | — | 55 | Schedule A not provided |
| Dental | Colonial Life & Accident Insurance Company | — | 55 | Schedule A not provided |
| Dental | Colonial Life & Accident Insurance Company | — | 55 | Schedule A not provided |
| Vision | Aetna Life Insurance Co. | Mcgriff, A Marsh & Mclennan Agency | 78 | $552 8.4% of $6,591 |
| Vision | Aetna Life Insurance Co. | Mcgriff Insurance Services Inc. | 78 | $71 1.1% of $6,591 |
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 $92,666
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group, LLC | Broker | $45,281 | $573.18 |
| Mcgriff Insurance Services (Pa), A | Broker | $29,385 | $371.96 |
| Aetna Health Plans | Admin | $18,000 | $227.85 |