Form 5500 · Employee benefit plan · BLOOMSBURG, PA
STEVE SHANNON TIRE COMPANY, INC.
The filing calls this plan STEVE SHANNON TIRE COMPANY, INC. HEALTH PLAN.
Public Form 5500 records show how STEVE SHANNON TIRE COMPANY, INC. of BLOOMSBURG, PA, a wholesale trade employer, structures its employee benefits. Coverage is written through HM LIFE INSURANCE COMPANY and 1 other carrier. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 23-2549609 · plan 501 · plan year 2024, filed Oct 14, 2025
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How this plan is funded
Self-funded as reported
The filing reports a stop-loss contract and no medical premium, which is what a plan that pays its own claims reports.
A stop-loss policy appears on a Form 5500 only when the plan itself is the beneficiary, or the premiums are paid from plan money. Many employers buy stop-loss and never report it here. So a plan with no stop-loss on its filing may still have it.
Benefits declared on this filing
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
All 2 insured contracts are stop-loss coverage, split across HM LIFE INSURANCE COMPANY and EVEREST REINSURANCE COMPANY.
The filing declares health. Health appears with no insured contract on Schedule A. That coverage may be self-funded, or placed with a carrier that is not on this filing.
The only insured piece of the health benefit is stop-loss coverage, and the filing reports the plan paying its own claims. The premium and commission here are for the stop-loss contract, not for medical premium.
Reported premium is $795,781; the filing discloses no broker commission on these contracts.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| HM LIFE INSURANCE COMPANY | Stop-loss | 252 | Jan 1, 2025 | $790,592 | $0 |
| EVEREST REINSURANCE COMPANY | Stop-loss | 0 | Jan 1, 2025 | $5,189 | $0 |
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
Named on Schedule C of this filing. We publish company names only.
Reported to OSHA
Reported to OSHA for 2025: 618 employees, 24 recordable cases, 611 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Other plans filed by this employer
How this plan compares
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