Employer
Waynesboro Hospital
501 East Main Street, Waynesboro, PA 17268 · EIN 23-1360854 · Jan 1, 2020 to Dec 31, 2020
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 $126,272
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Sun Life Assurance Company Of Canada | Usi Southwest Inc | 322 | $8,083 6.1% of $133,124 |
| Stop-loss | Sun Life Assurance Company Of Canada | Usi Insurance Services (Ri) | 322 | $5,654 4.2% of $133,124 |
| Dental | Delta Dental Of Pennsylvania | — | 298 | Schedule A not provided |
| Vision | Capital Advantage Assurance Company | Marty Miracle | 311 | $141 2.0% of $7,033 |
| Life | Life Insurance Company Of North America | — | 346 | Schedule A not provided |
| Life | Life Insurance Company Of North America | — | 346 | Schedule A not provided |
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.