| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SHOLLEY AGENCY3 Filed as: THE SHOLLEY AGENCY INC | PO BOX 308 LEWISBURG, PA 17837 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | $0 | $2K | 9.69% |
| U R L INC3 | 500 NATIONWIDE DR HARRISBURG, PA 17110 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $636 | $636 | 4.03% |
| DEER INSURANCE GROUP LLC3 | 300 EDGAR AVE BLOOMSBURG, PA 17815 | PRINCIPAL LIFE INSURANCE COMPANY | $5 | $0 | $5 | 0.03% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| GEISINGER HEALTH PLAN EIN 23-2815174 ADMIN | Claims processing Service code 12 | — | $11K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $9K |
| SHOLLEY AGENCY, INC. BROKER | Insurance agents and brokers Service code 22 | 2409 OLD TURNPIKE RD LEWISBURG, PA 17837 | $8K |
| CONNECTCARE3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $2K |
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 30 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 30 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 42 | $16K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 42 | $16K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 42 | $16K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 24 | $122K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 42 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.