Employer
Solomon C. Luo, M.D., P.C.
201 E. Laurel Boulevard, Pottsville, PA 17901 · EIN 23-2413259 · Jan 1, 2021 to Dec 31, 2021
Plan year 2021
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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.
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Everest Reinsurance Company | — | — | Comp not disclosed Premium $165,271 |
| Dental | Metropolitan Life Insurance Company | — | — | Schedule A not provided |
| Life | Kemper Life | — | — | Schedule A not provided |
| Life | Companion Life Insurance Company | — | — | Schedule A not provided |
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.
Visible subtotal $31,632
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Tompkins Insurance Agencies, Inc. | Broker | $8,675 | $166.83 |
| The Benecon Group | Broker | $8,378 | $161.12 |
| Eta Benefits Inc | Broker | $2,275 | $43.75 |
| Capital Blue Cross | Admin | $10,070 | $193.65 |
| Connectcare 3 | Patient Advocate | $2,234 | $42.96 |