Employer
Fulton County Medical Center
214 Peach Orchard Road, Mcconnellsburg, PA 17233 · EIN 23-1401561 · Jan 1, 2025 to Dec 31, 2025
Plan year 2025
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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 $34,760
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Sun Life Assurance Company Of Canada | Usi Southwest Inc | 54 | $8,345 20.1% of $41,580 |
| Medical | Sun Life Assurance Company Of Canada | Usi Insurance Services (Ri) | 54 | $2,225 5.4% of $41,580 |
| Vision | National Vision Administrators, LLC | Martin R Miracle | 444 | $3,187 10.0% of $31,875 |
| Life | Hartford Life And Accident | Usi Southwest Inc | 320 | $21,003 12.1% of $173,088 |
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 $-218,004
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Highmark Inc | Contractor | $-218,004 | $-491.00 |