Employer

Service Solutions, Inc. DBA Systems Solution, Inc.

376 Crooked Lane, King Of Prussia, PA 19406 · EIN 23-2655840 · Dec 1, 2022 to Nov 30, 2023

Plan year 2022

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Schedule A

Direct compensation

Coverage contracts on the filing. If the carrier did not provide Schedule A, the row is listed with that note.

Visible subtotal $31,977

Coverage	Carrier	Broker	Lives	Direct comp
Medical	Cigna Health And Life Insurance Company	Pentra LLC	118	$23,949 5.0% of $478,984
Medical	Cigna Health And Life Insurance Company	Pentra LLC	118	$2,134 0.4% of $478,984
Dental + Vision	Cigna Health And Life Insurance Company And Affiliates	Pentra LLC	104	$2,180 7.3% of $29,679
Life	Life Insurance Company Of North America	Pentra LLC	146	$1,531 11.9% of $12,896
Life	Life Insurance Company Of North America	National Benefit Center	146	$252 2.0% of $12,896
Life	Life Insurance Company Of North America	American Insurance Administrators	146	$55 0.4% of $12,896
AD&D	Life Insurance Company Of North America	Pentra LLC	146	$352 11.9% of $2,957
AD&D	Life Insurance Company Of North America	National Benefit Center	146	$58 2.0% of $2,957
AD&D	Life Insurance Company Of North America	American Insurance Administrators	146	$12 0.4% of $2,957
Other	Life Insurance Company Of North America	Pentra LLC	114	$721 11.9% of $6,073
Other	Life Insurance Company Of North America	National Benefit Center	114	$119 2.0% of $6,073
Other	Life Insurance Company Of North America	American Insurance Administrators	114	$26 0.4% of $6,073
Other	Life Insurance Company Of North America	Pentra LLC	114	$490 11.9% of $4,133
Other	Life Insurance Company Of North America	National Benefit Center	114	$81 2.0% of $4,133
Other	Life Insurance Company Of North America	American Insurance Administrators	114	$17 0.4% of $4,133

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.

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