| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CONSTANCE A TREIBLE3 | 128 WILLIAMS ROAD CRESCO, PA 18326 | AFLAC | $5K | $247 | $5K | 7.41% |
| STEPHEN D BISSELL3 Filed as: STEPHEN D BISSEL | 5465 AMANDA DRIVE LAURYS STATION, PA 18059 | AFLAC | $2K | $123 | $3K | 3.61% |
| JAMES ZARODA3 Filed as: JAMES B ZARODA | 24 INDEPENDENCE ROAD MOUNTAIN TOP, PA 18707 | AFLAC | $2K | — | $2K | 2.27% |
| JEFFREY CHUBB3 | 520 W 4TH STREET STE 1A WILLIAMSPORT, PA 17701 | AFLAC | $1K | $123 | $1K | 1.67% |
| DOUGLAS R. BORLAND3 Filed as: DOUGLAS R BORLAND | 919 SCOTT STREET WILKES BARRE, PA 18705 | AFLAC | $1K | $108 | $1K | 1.58% |
| KEITH LOWTHERT3 | 1699 WYOMING AVENUE FORTY FORT, PA 18704 | AFLAC | $789 | $107 | $896 | 1.27% |
| DAVID CALBY3 | 10 HINDS STREET MONTROSE, PA 18801 | AFLAC | $791 | — | $791 | 1.12% |
| MG BERGER INC3 | 1020 N DELAWARE AVE STE 4 PHILADELPHIA, PA 19125 | AFLAC | $352 | $123 | $475 | 0.67% |
| WILSON H TRANSUE3 | 1487 SULLIVAN TRAIL TANNERSVILLE, PA 18372 | AFLAC | $339 | — | $339 | 0.48% |
| FRED A REEDER3 Filed as: FRED E REEDER | 380 E MAIN STREET LOCK HAVEN, PA 17745 | AFLAC | $187 | — | $187 | 0.26% |
| C A LUPP INC3 Filed as: O A LUPP INC | 441 FRIENDSHIP ROAD STE 102 HARRISBURG, PA 17111 | AFLAC | $170 | — | $170 | 0.24% |
| JOSEPH G GRABLICK3 | 716 SUSQUEHANNA AVE WYOMING, PA 18644 | AFLAC | $137 | — | $137 | 0.19% |
| DEBRA PIERCE3 Filed as: DEBRA J PIERCE | 2108 SLOCUM ROAD MOUNTAIN TOP, PA 18707 | AFLAC | $104 | — | $104 | 0.15% |
| ALEXANDER BATISTA3 | 1 KINGS AVENUE EASTON, PA 18045 | AFLAC | $83 | — | $83 | 0.12% |
| DIVERSIFIED SOLUTIONS GROUP INC3 | PO BOX 211 YOUNGWOOD, PA 15697 | AFLAC | $79 | — | $79 | 0.11% |
| DAVID W RANCK3 | PO BOX 277 EPHRATA, PA 17522 | AFLAC | $61 | — | $61 | 0.09% |
| MARK D BARBIER3 | 802 DEER TRAIL LANE OAK BROOK, IL 60523 | AFLAC | $56 | — | $56 | 0.08% |
| DIANNE L MARTIN3 | 125 MANOR STREET HARRISBURG, PA 17110 | AFLAC | $51 | — | $51 | 0.07% |
| JOSEPH F. SULLIVAN3 Filed as: JOSEPH F SULLIVAN | 1058 COMMANCHE TRAIL GOULDSBORO, PA 18424 | AFLAC | $46 | — | $46 | 0.07% |
| SEAN T JUDGE3 | 95 POPLAR ST KINGSTON, PA 18704 | AFLAC | $45 | — | $45 | 0.06% |
| JOHN M WASHO3 | 106 CEDAR BLUFF COURT ALEDO, TX 76008 | AFLAC | $43 | — | $43 | 0.06% |
| KEN E FOSTER3 | 3527 US HIGHWAY 52 DECORAH, IA 52101 | AFLAC | $34 | — | $34 | 0.05% |
| RANDALL SIMS3 | 138 DERR DR COLLEGVILLE, PA 19426 | AFLAC | $30 | — | $30 | 0.04% |
| JOSEPH RYNCAVAGE3 | 140 MAIN STREET KINGSTON, PA 18704 | AFLAC | $29 | — | $29 | 0.04% |
| PETER R. TREIBLE3 Filed as: PETER R TREIBLE | 128 WILLIAMS ROAD CRESCO, PA 18326 | AFLAC | $20 | — | $20 | 0.03% |
| LISA A BROMAGE3 | 157 SPRING STREET SCRANTON, PA 18508 | AFLAC | $18 | — | $18 | 0.03% |
| JACK A MARTIN3 | 93 WOODSIDE RD DANVILLE, PA 17821 | AFLAC | $11 | — | $11 | 0.02% |
| BLACK ROK BENEFIT ALLIANCE LLC3 | PO BOX 211 YOUNGWOOD, PA 15697 | AFLAC | $7 | — | $7 | 0.01% |
| WILLIAM M KNOTT3 | 330 EVANSDALE ROAD LAKE MARY, FL 32746 | AFLAC | $4 | — | $4 | 0.01% |
| DANIEL R JUDY3 | 231 WALTERS MILL RD SOMERSET, PA 15501 | AFLAC | $2 | — | $2 | 0.00% |
No Schedule C service providers reported on this filing.
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 | 147 | 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) | 147 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AFLAC | 147 | $71K |
| Vision | AFLAC | 147 | $71K |
| Life insurance | AFLAC | 147 | $71K |
| Short-term disability | AFLAC | 147 | $71K |
| Other | AFLAC | 147 | $71K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 147 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
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.