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Employer
2001 Market St, Philadelphia, PA 19103 · EIN 23-1141190 · May 1, 2022 to Apr 30, 2023
Plan year 2022
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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 $14,962
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Independence Blue Cross | — | 80 | Comp not disclosed Premium $821,893 |
| Dental | Aetna Life Insurance Company | Capital Management Enterprises Inc | 89 | $2,066 6.0% of $34,554 |
| Dental | Aetna Life Insurance Company | Emerson Reid, LLC | 89 | $1,989 5.8% of $34,554 |
| Vision | Vision Benefits Of America | Capital Management Enterprises Inc | 43 | $203 5.0% of $4,064 |
| Life | Life Insurance Company Of North America | Capital Management Enterprises Inc | 72 | $1,364 13.4% of $10,166 |
| Accidental Death & Dismemberment | Life Insurance Company Of North America | Capital Management Enterprises Inc | 72 | $298 13.4% of $2,224 |
| Other | Life Insurance Company Of North America | Capital Management Enterprises Inc | 72 | $3,657 13.4% of $27,322 |
| Other | Life Insurance Company Of North America | Capital Management Enterprises Inc | 72 | $5,385 13.4% of $40,150 |
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 $3,361
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Capital Management Enterprises | None | $3,361 | $32.01 |