| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SHOLLEY AGENCY3 Filed as: SHOLLEY AGENCY INC | 2409 OLD TURNPIKE RD LEWISBURG, PA 17837 | DELTA DENTAL OF PENNSYLVANIA | $3K | $0 | $3K | 10.00% |
| ASSUREDPARTNERS3 Filed as: EMERSON ROGERS LLC | 1787 SENTRY PKWY W, STE 320 BLUE BELL, PA 19422 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $1K | $3K | 20.66% |
| SHOLLEY AGENCY3 Filed as: SHOLLEY AGENCY INC | 2409 OLD TURNPIKE RD LEWISBURG, PA 17837 | NATIONAL VISION ADMINISTRATORS, LLC | $407 | $0 | $407 | 5.00% |
| OPTAVISE, LLC3 Filed as: OPTAVISE LLC | 120 18TH ST S BIRMINGHAM, AL 35233 | WASHINGTON NATIONAL INSURANCE COMPANY | $53 | $0 | $53 | 0.76% |
| MICHAEL TENDLER3 | 216 W MARKET ST PILLOW, PA 17080 | WASHINGTON NATIONAL INSURANCE COMPANY | $34 | $0 | $34 | 0.49% |
| MARILYN OLIN3 | 44 HILLTOP DR CHURCHVILLE, PA 18966 | WASHINGTON NATIONAL INSURANCE COMPANY | $34 | $0 | $34 | 0.49% |
| JAMES A TOMKO3 | 12185 MONNIE AVE CONNEAUT LAKE, PA 16316 | WASHINGTON NATIONAL INSURANCE COMPANY | $16 | $0 | $16 | 0.23% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: RICHARD S LEE | 555 BAYVIEW DR BELLEAIR, FL 33756 | WASHINGTON NATIONAL INSURANCE COMPANY | $15 | $0 | $15 | 0.21% |
| MICHAEL FOSTER3 Filed as: MICHAEL A FOSTER | 21251 MARSH HAWK DR LAND O LAKES, FL 34638 | WASHINGTON NATIONAL INSURANCE COMPANY | $14 | $0 | $14 | 0.20% |
| SCOTT A YOUNG3 | 647 EDISON AVE SUNBURY, PA 17801 | WASHINGTON NATIONAL INSURANCE COMPANY | $10 | $0 | $10 | 0.14% |
| NICHOLAS BARATTINI3 Filed as: NICHOLAS DAVID BARATTINI | 1142 ANGELICA LN TEGA CAY, SC 29708 | WASHINGTON NATIONAL INSURANCE COMPANY | $7 | $0 | $7 | 0.10% |
| EMILY D ROTTSCHEIT3 | 65 CHESTNUT ST BEAVER SPRINGS, PA 17812 | WASHINGTON NATIONAL INSURANCE COMPANY | $5 | $0 | $5 | 0.07% |
| BARBARA A KENNEDY3 | 122 E WATER ST MUNCY, PA 17756 | AFLAC | $141 | $0 | $141 | 2.11% |
| DAVID M RYNCAVAGE SR3 | 324 W MAIN ST PLYMOUTH, PA 18651 | AFLAC | $93 | $0 | $93 | 1.39% |
| WILSON H TRANSUE3 | 1487 SULLIVAN TRL TANNERSVILLE, PA 18372 | AFLAC | $60 | $0 | $60 | 0.90% |
| JOSEPH B MCGINTY JR3 | 2202 CROSS CREEK RD MACUNGIE, PA 18062 | AFLAC | $52 | $0 | $52 | 0.78% |
| FRED A REEDER3 | 109 WOODWARD AVE LOCK HAVEN, PA 18210 | AFLAC | $48 | $0 | $48 | 0.72% |
| KEVIN D NOLL3 | PO BOX 29 ALBRIGHTSVILLE, PA 18210 | AFLAC | $34 | $0 | $34 | 0.51% |
| DANIEL R JUDY3 | 231 WALTERS MILL RD SOMERSET, PA 15501 | AFLAC | $23 | $0 | $23 | 0.34% |
| JEFFREY CHUBB3 Filed as: JEFFREY C CHUBB | 349 W WALNUT TREE DR BLANDON, PA 19510 | AFLAC | $15 | $0 | $15 | 0.22% |
| HARRY D WAGNER3 | PO BOX 7247 AUDUBON, PA 19407 | AFLAC | $14 | $0 | $14 | 0.21% |
| DANIEL CERO3 | 1936 MOUNT VIEW AVE MONTOURSVILLE, PA 17754 | AFLAC | $9 | $0 | $9 | 0.13% |
| IRENE E BROOKS3 | 19 NORFOLK LN LEBANON, PA 17042 | AFLAC | $8 | $0 | $8 | 0.12% |
| JOHN M WASHO3 | 24956 WOLF BAY TER ORANGE BEACH, AL 36561 | AFLAC | $8 | $0 | $8 | 0.12% |
| CHARLES L ROUSER3 | 1771 KITCHENEN'S CT NAPLES, FL 34109 | AFLAC | $1 | $0 | $1 | 0.01% |
| ASSUREDPARTNERS3 Filed as: EMERSON ROGERS LLC | 1787 SENTRY PKWY W, STE 320 BLUE BELL, PA 19422 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $471 | $540 | $1K | 21.45% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SHOLLEY AGENCY, INC. BROKER | Insurance agents and brokers Service code 22 | 2409 OLD TURNPIKE RD LEWISBURG, PA 17837 | $19K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $15K |
| CONNECTCARE3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $4K |
| CAPITAL BLUECROSS EIN 23-0455154 ADMIN | Claims processing Service code 12 | — | -$23K |
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 | 74 | 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) | 74 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF PENNSYLVANIA | 99 | $34K |
| Vision | NATIONAL VISION ADMINISTRATORS, LLC | 119 | $8K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 74 | $5K |
| Short-term disability | AFLAC | 10 | $7K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | HM LIFE INSURANCE COMPANY | 59 | $387K |
| Other(4 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 74 | $32K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 119 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.