Employer
Northeastern Eye Institute
200 Mifflin Ave, Scranton, PA 18503 · EIN 23-2287632 · Jun 1, 2020 to May 31, 2021
Plan year 2020
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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 $29,615
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Highmark, Inc. | N/A | 238 | Comp not disclosed Premium $1,457,658 |
| Medical | Highmark, Inc. | Dehey Mcandrew | 53 | $6,000 |
| Life | Cigna Life Insurance Of North America | Triben Insurance Solution | 245 | $5,461 22.5% of $24,278 |
| Life | Cigna Life Insurance Of North America | Triben Insurance Solution | 245 | $54 17.1% of $315 |
| Dental | Guardian | Triben Insurance Solutions | 68 | $1,148 10.0% of $11,484 |
| Other | Cigna Life Insurance Of North America | Triben Insurance Solution | 245 | $12,507 18.4% of $68,115 |
| Life | Cigna Life Insurance Of North America | Triben Insurance Solution | 57 | $4,445 18.1% of $24,505 |
Schedule C
Additional compensation
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.