Employer
Corry Memorial Hospital
965 Shamrock Lane, Corry, PA 16407 · EIN 25-0987222 · Feb 1, 2015 to Jan 31, 2016
Plan year 2015
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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 $21,452
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | Hubbard Bert Karle Weber, Inc. | — | $21,452 10.0% of $214,516 |
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 $79,841
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Highmark | None | $79,841 | $682.40 |
| Hubbard Bert Karle Weber, Inc. | None | Comp not disclosed | — |
| Medco Health Solutions | None | Comp not disclosed | — |