Employer
Keystone Rural Health Center
111 Chambers Hill Drive, Suite 200, Chambersburg, PA 17201 · EIN 25-1546810 · 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 $321,334
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Highmark, Inc. | Martin Ray Miracle | 803 | $270,510 3.2% of $8,478,038 |
| Dental | United Concordia Insurance Company | Usi Southwest, Inc. | 954 | $9,412 4.8% of $194,226 |
| Vision | National Vision Administrators, L.L.C. | Martin R. Miracle | 848 | $3,688 10.0% of $36,877 |
| Life | Unitedhealthcare Insurance Company | Usi Southwest, Inc. - Houston | 638 | $37,724 10.0% of $377,236 |
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 $10,444
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Flores And Associates | None | $10,444 | $10.95 |