Employer
Monongahela Valley Hospital
1163 Country Club Road, Monongahela, PA 15063 · EIN 23-7218917 · Jul 1, 2021 to Jun 30, 2022
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.
Visible subtotal $60,244
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Dental | Cigna Health And Life Insurance Company | Valley Health Admin Ins Agcy, Inc | 355 | $6,461 4.5% of $144,307 |
| Dental | Cigna Health And Life Insurance Company | Valley Health Admini Ins Agcy, Inc | 532 | $9,692 4.5% of $216,461 |
| Other | Life Insurance Company Of North America | Valley Health Administrat | 214 | $4,037 7.9% of $50,965 |
| Other | Life Insurance Company Of North America | Valley Health Adminstrat | 525 | $9,883 7.9% of $124,775 |
| Other | Life Insurance Company Of North America | Valley Health Administrat | 214 | $721 7.3% of $9,875 |
| Other | Life Insurance Company Of North America | Valley Health Administrat | 525 | $1,765 7.3% of $24,177 |
| Life | Life Insurance Company Of North America | Valley Health Administrat | 525 | $19,656 12.5% of $157,468 |
| Vision | HM Insurance Company | — | 803 | Comp not disclosed Premium $47,632 |
| Vision | HM Insurance Company | — | 432 | Comp not disclosed Premium $25,649 |
| Life | Life Insurance Company Of North America | Valley Health Administrat | 214 | $8,029 12.5% of $64,318 |
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.