Employer
Chambersburg Hospital
112 North Seventh Street, Chambersburg, PA 17201 · EIN 23-0465970 · Nov 1, 2022 to Dec 31, 2022
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 $14,249
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Dental | Delta Dental Of Pennsylvania | — | 2581 | Schedule A not provided |
| Vision | HM Life Insurance Company | — | 2544 | Comp not disclosed Premium $5,044 |
| Life | The Lincoln National Life Insurance Company | Martin R. Miracle | 1675 | $4,777 6.4% of $74,859 |
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.