| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SEFCHOK & ASSOCIATES3 | 223 W PITTSBURGH ST GREENSBURG, PA 15601 | UPMC HEALTH OPTIONS | $11K | $0 | $11K | 2.00% |
| SEFCHOK & ASSOCIATES3 | 223 W PITTSBURGH ST GREENSBURG, PA 15601 | UPMC HEALTH OPTIONS | $5K | $0 | $5K | 2.00% |
| GARY S SEFCHOK3 | 223 W PITTSBURGH ST GREENSBURG, PA 15601 | DEARBORN LIFE INSURANCE COMPANY | $8K | $0 | $8K | 12.24% |
| EMERSON REID LLC3 | 1305 WALT WHITMAN RD STE 310 MELVILLE, NY 11747 | AMERITAS LIFE INSURANCE CORP | $3K | $0 | $3K | 5.00% |
| ENGLE-HAMBRIGHT & DAVIES, INC.3 Filed as: ENGLE HAMBRIGHT & DAVIES | PO BOX 11600 1857 WILLIAM PENN WAY LANCASTER, PA 17601 | AMERITAS LIFE INSURANCE CORP | $3K | $0 | $3K | 4.49% |
| WILLIAM S. LAW3 Filed as: WILLIAM S LAW | 600 KINGFRED DRIVE HUNTINGTON, PA 15642 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $0 | $3K | 18.64% |
| NORTHWEST WORKSITE MARKETING CORP3 | 1910 INDIAN WOOD CIRCLE MAUMEE, OH 43537 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $141 | $2K | 12.85% |
| PETERSON FINANCIAL INC3 | 548 CANTON ROAD WINTERSVILLE, OH 43953 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $0 | $2K | 12.66% |
| GARY S SEFCHOK3 | 233 WEST PITTSBURGH STREET GREENSBURG, PA 15601 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $0 | $2K | 10.55% |
| CBF BENEFITS INC3 | 1309 HIDDEN HARBOR ROAD MYRTLE BEACH, SC 29577 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $54 | $2K | 9.81% |
| NORTHWEST ENROLLX LLC3 | 7656 TWP ROAD 94 FINDLAY, OH 45840 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $110 | $0 | $110 | 0.72% |
| DONNA TROXELL3 | 706 WESTWOOD DRIVE GIBSONIA, PA 15044 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $53 | $37 | $90 | 0.59% |
| TIMOTHY BIRDSONG3 | 302 FIELDBROOK DRIVE WASHINGTON, PA 15301 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $53 | $10 | $63 | 0.41% |
| JAMES DANIEL MARTINETTE3 | 128 GLEN HOLLIN DRIVE WHEELING, WV 26003 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $39 | $3 | $42 | 0.27% |
| SEFCHOK & ASSOCIATES3 | 233 W PITTSBURGH ST GREENSBURG, PA 15601 | UPMC HEALTH BENEFITS | $471 | $0 | $471 | 4.05% |
| SEFCHOK & ASSOCIATES3 | 223 W PITTSBURGH ST GREENSBURG, PA 15601 | UPMC HEALTH OPTIONS | $217 | $0 | $217 | 2.00% |
| SEFCHOK & ASSOCIATES3 | 223 W PITTSBURGH ST GREENSBURG, PA 15601 | UPMC HEALTH OPTIONS | $124 | $0 | $124 | 2.00% |
| SEFCHOK & ASSOCIATES3 | 223 W PITTSBURGH ST GREENSBURG, PA 15601 | UPMC HEALTH BENEFITS | $10 | $0 | $10 | 4.59% |
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 | 169 | 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) | 169 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts) | UPMC HEALTH OPTIONS | 79 | $792K |
| Dental | AMERITAS LIFE INSURANCE CORP | 325 | $60K |
| Vision(2 contracts) | UPMC HEALTH BENEFITS | 276 | $12K |
| Life insurance(2 contracts, 2 carriers) | DEARBORN LIFE INSURANCE COMPANY | 169 | $78K |
| Short-term disability | DEARBORN LIFE INSURANCE COMPANY | 169 | $63K |
| Long-term disability | DEARBORN LIFE INSURANCE COMPANY | 169 | $63K |
| Other(2 contracts, 2 carriers) | DEARBORN LIFE INSURANCE COMPANY | 169 | $78K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 325 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.