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Employer
123 Coulter Avenue, Ardmore, PA 19003 · EIN 27-5427373 · Jan 1, 2021 to Dec 31, 2021
Plan year 2021
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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 $3,434
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Everest Reinsurance Company | — | — | Comp not disclosed Premium $341 |
| Stop-loss | HM Life Insurance Company | — | 46 | Comp not disclosed Premium $196,205 |
| Dental | Aetna Life Insurance Co | Nfp Corporate Services (Pa), Inc. | 56 | $1,883 7.0% of $26,945 |
| Vision | Vision Benefits Of America | Nfp Corporate Services (Pa), Inc. | 47 | $187 5.0% of $3,734 |
| Life | Prudential | Nfp Corp. Services (Pa) Inc. | 56 | $1,159 15.0% of $7,729 |
| Life | Prudential | Cambridge Consulting Group LLC | 56 | $194 2.5% of $7,729 |
| Life | Prudential | Img | 56 | $11 0.1% of $7,729 |
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 $55,918
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Nfp Corporate Services (Pa), Inc. | Broker | $21,398 | $329.20 |
| The Benecon Group, Inc. | Broker | $9,554 | $146.98 |
| Independence Administrators | Admin | $22,268 | $342.58 |
| ConnectCare3 | Patient Advocate | $2,698 | $41.51 |