| 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 | $4K | $0 | $4K | 10.00% |
| BARBARA A KENNEDY3 | 122 E WATER ST MUNCY, PA 17756 | AFLAC | $107 | $0 | $107 | 1.54% |
| DAVID M RYNCAVAGE SR3 | 324 W MAIN ST PLYMOUTH, PA 18651 | AFLAC | $93 | $0 | $93 | 1.33% |
| WILSON H TRANSUE3 | 1487 SULLIVAN TRL TANNERSVILLE, PA 18372 | AFLAC | $60 | $0 | $60 | 0.86% |
| HARRY D WAGNER3 | PO BOX 7247 AUDUBON, PA 19407 | AFLAC | $56 | $0 | $56 | 0.80% |
| JOSEPH B MCGINTY JR3 | 2202 CROSS CREEK RD MACUNGIE, PA 18062 | AFLAC | $52 | $0 | $52 | 0.75% |
| FRED A REEDER3 | 109 WOODWARD AVE LOCK HAVEN, PA 18210 | AFLAC | $48 | $0 | $48 | 0.69% |
| KEVIN D NOLL3 | PO BOX 29 ALBRIGHTSVILLE, PA 18210 | AFLAC | $34 | $0 | $34 | 0.49% |
| DANIEL R JUDY3 | 231 WALTERS MILL RD SOMERSET, PA 15501 | AFLAC | $23 | $0 | $23 | 0.33% |
| JEFFREY CHUBB3 Filed as: JEFFREY C CHUBB | 349 W WALNUT TREE DR BLANDON, PA 19510 | AFLAC | $15 | $0 | $15 | 0.22% |
| 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 | 0.11% |
| JOHN M WASHO3 | 24956 WOLF BAY TER ORANGE BEACH, AL 36561 | AFLAC | $8 | $0 | $8 | 0.11% |
| CHARLES L ROUSER3 | 1771 KITCHENEN'S CT NAPLES, FL 34109 | AFLAC | $5 | $0 | $5 | 0.07% |
| MICHAEL TENDLER3 | 216 W MARKET ST PILLOW, PA 17080 | WASHINGTON NATIONAL INSURANCE COMPANY | $543 | $0 | $543 | 7.81% |
| OPTAVISE, LLC3 Filed as: OPTAVISE LLC | 120 18TH ST S BIRMINGHAM, AL 35233 | WASHINGTON NATIONAL INSURANCE COMPANY | $459 | $0 | $459 | 6.60% |
| MARILYN OLIN3 | 44 HILLTOP DR CHURCHVILLE, PA 18966 | WASHINGTON NATIONAL INSURANCE COMPANY | $195 | $0 | $195 | 2.80% |
| SCOTT A YOUNG3 | 647 EDISON AVE SUNBURY, PA 17801 | WASHINGTON NATIONAL INSURANCE COMPANY | $177 | $0 | $177 | 2.54% |
| EMILY D ROTTSCHEIT3 | 65 CHESTNUT ST BEAVER SPRINGS, PA 17812 | WASHINGTON NATIONAL INSURANCE COMPANY | $76 | $0 | $76 | 1.09% |
| NICHOLAS BARATTINI3 Filed as: NICHOLAS DAVID BARATTINI | 1142 ANGELICA LN TEGA CAY, SC 29708 | WASHINGTON NATIONAL INSURANCE COMPANY | $59 | $0 | $59 | 0.85% |
| JAMES A TOMKO3 | 12185 MONNIE AVE CONNEAUT LAKE, PA 16316 | WASHINGTON NATIONAL INSURANCE COMPANY | $50 | $0 | $50 | 0.72% |
| PEGGY A REINARD3 | 776 APP RD SELINSGROVE, PA 17870 | WASHINGTON NATIONAL INSURANCE COMPANY | $43 | $0 | $43 | 0.62% |
| LARRY L NEWMAN3 Filed as: LARRY NEWMAN DBA K.E.I.A. | PO BOX 815 SUNBURY, PA 17801 | WASHINGTON NATIONAL INSURANCE COMPANY | $40 | $0 | $40 | 0.58% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: RICHARD S LEE | 555 BAYVIEW DR BELLEAIR, FL 33756 | WASHINGTON NATIONAL INSURANCE COMPANY | $39 | $0 | $39 | 0.56% |
| MICHAEL FOSTER3 Filed as: MICHAEL A FOSTER | 21251 MARSH HAWK DR LAND O LAKES, FL 34638 | WASHINGTON NATIONAL INSURANCE COMPANY | $39 | $0 | $39 | 0.56% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: RICHARD S LEE | 555 BAYVIEW DR BELLEAIR, FL 33756 | WASHINGTON NATIONAL INSURANCE COMPANY | $30 | $0 | $30 | 0.43% |
| MICHAEL FOSTER3 Filed as: MICHAEL A FOSTER | 21251 MARSH HAWK DR LAND O LAKES, FL 34638 | WASHINGTON NATIONAL INSURANCE COMPANY | $29 | $0 | $29 | 0.42% |
| TERRY LEE MCCONNELL3 | 1708 3RD AVE ALTOONA, PA 16602 | WASHINGTON NATIONAL INSURANCE COMPANY | $26 | $0 | $26 | 0.37% |
| ROBERT FREDERICK CLARK3 | 77 PRIVATE RD 1029 INDIANA, PA 15781 | WASHINGTON NATIONAL INSURANCE COMPANY | $5 | $0 | $5 | 0.07% |
| JENNIFER SHROPSHIRE3 | PO BOX 912 DUBOIS, PA 15801 | WASHINGTON NATIONAL INSURANCE COMPANY | $3 | $0 | $3 | 0.04% |
| DENISE MARIE GONZALEZ3 | 730 CLAY PIKE RD ACME, PA 15610 | WASHINGTON NATIONAL INSURANCE COMPANY | $2 | $0 | $2 | 0.03% |
| CHERYL J MATTERN3 | 14454 W CENTER RD SPRINGBORO, PA 16435 | WASHINGTON NATIONAL INSURANCE COMPANY | $1 | $0 | $1 | 0.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SHOLLEY AGENCY, INC. BROKER | Insurance agents and brokers Service code 22 | 2409 OLD TURNPIKE RD LEWISBURG, PA 17837 | $18K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $14K |
| CONNECTCARE3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $4K |
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 | 65 | 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) | 65 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF PENNSYLVANIA | 50 | $36K |
| Short-term disability | AFLAC | 10 | $7K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 65 | $304K |
| Other(2 contracts, 2 carriers) | AFLAC | 11 | $14K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 65 | — |
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.