Employer
Three Rivers Orthopaedic Spine Pro
5103 Center Drive Suite A, Latrobe, PA 15650 · EIN 20-8024741 · Feb 1, 2020 to Jan 31, 2021
Plan year 2020
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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 $1,569
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Other | Mutual Of Omaha Insurance Company | Thomas M Stanton | 133 | $242 |
| Other | Mutual Of Omaha Insurance Company | Stuart D. Fox | 133 | $130 |
| Other | Mutual Of Omaha Insurance Company | Thomas M. Stanton | 132 | $778 |
| Other | Mutual Of Omaha Insurance Company | Stuart D. Fox | 132 | $419 |
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.