| 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. | $42K | — | $42K | 21.15% |
| LYMAN A. FULTON III3 Filed as: LYMAN FULTON | PO BOX 628 JOHNSON SITY, TN 37605 | PRINCIPAL LIFE INSURANCE COMPANY | $29K | — | $29K | 19.26% |
| PHILLIP GOODRUM3 | 131 HILLSIDE AVE CHARLOTTE, NC 28209 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $20K | — | $20K | 13.33% |
| LYMAN A. FULTON III3 | PO BOX 628 JOHNSON CITY, TN 37605 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $12K | — | $12K | 7.81% |
| 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 | $2K | — | $2K | 5.45% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUECROSS BLUESHIELD OF TENNESSEE EIN 62-0427913 NONE | Contract Administrator Service code 13 | — | $264K |
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 | 472 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 472 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | 1,015 | $391K |
| Dental | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | 1,015 | $199K |
| Life insurance(3 contracts, 3 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 581 | $345K |
| Long-term disability(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 472 | $196K |
| Other | GUARDIAN | 194 | $45K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,015 | — |
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.