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Employer
1600 Market Street, Philadelphia, PA 19103 · EIN 84-4034514 · 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 $37,565
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 189 | Comp not disclosed Premium $746,743 |
| Medical | Hawaii Medical Assurance Association | Gavin Toma | 5 | $565 2.5% of $22,379 |
| Dental + Vision | Starmount Life Insurance Company | Birch Benefits, LLC | 214 | $18,448 10.7% of $172,571 |
| Life | Unum Life Insurance Company Of America | Birch Benefits, LLC | 260 | $10,414 9.0% of $116,312 |
| AD&D | Unum Life Insurance Company Of America | Birch Benefits, LLC | 106 | $4,663 15.4% of $30,357 |
| Dbl | First Unum Life Insurance Company | Birch Benefits, LLC | 44 | $2,592 14.7% of $17,586 |
| Other | Unum Life Insurance Company Of America | Birch Benefits, LLC | 12 | $613 14.6% of $4,204 |
| Other | Unum Life Insurance Company Of America | Birch Benefits, LLC | 5 | $270 10.8% of $2,497 |
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 $333,444
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group LLC | Broker | $142,072 | $546.43 |
| Birch Benefits | Broker | $106,200 | $408.46 |
| Meritain Health | Admin | $85,172 | $327.58 |