| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LYMAN A. FULTON III3 | PO BOX 628 JOHNSON CITY, TN 37605 | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | $47K | — | $47K | 21.87% |
| PHILLIP GOODRUM3 | 131 HILLSIDE AVE CHARLOTTE, NC 28209 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $10K | — | $10K | 6.51% |
| LYMAN A. FULTON III3 | PO BOX 628 JOHNSON CITY, TN 37605 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $6K | — | $6K | 3.73% |
| LYMAN A. FULTON III3 Filed as: LYMAN FULTON | PO BOX 628 JOHNSON CITY, TN 37605 | HARTFORD LIFE AND ACCIDENT | $10K | — | $10K | 8.21% |
| LYMAN A. FULTON III3 Filed as: LYMAN A. FULTON | P.O. BOX 628 JOHNSON CITY, TN 37605 | GUARDIAN | $6K | — | $6K | 13.00% |
| LYMAN A. FULTON III3 | PO BOX 628 JOHNSON CITY, TN 376050628 | UNITED HEALTHCARE INSURANCE COMPANY | $3K | — | $3K | 5.41% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUECROSS BLUESHIELD OF TENNESSEE EIN 62-0427913 NONE | Contract Administrator Service code 13 | — | $270K |
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 | 483 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 483 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | 1,074 | $424K |
| Dental | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | 1,074 | $216K |
| Life insurance(3 contracts, 3 carriers) | AMERICAN HERITAGE LIFE INSURANCE COMPANY | 507 | $335K |
| Long-term disability(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 507 | $176K |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 507 | $176K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,074 | — |
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.