| 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. | $45K | — | $45K | 20.18% |
| LYMAN A. FULTON III3 Filed as: LYMAN FULTON | PO BOX 628 JOHNSON CITY, TN 37605 | PRINCIPAL LIFE INSURANCE COMPANY | $34K | — | $34K | 18.72% |
| LYMAN A. FULTON III3 | PO BOX 628 JOHNSON CITY, TN 37605 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $3K | — | $3K | 2.40% |
| I BENEFIT COMMUNICATION LLC3 | 131 HILLSIDE AVENUE CHARLOTTE, NC 28209 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $1K | — | $1K | 1.22% |
| BAYVIEW BENEFITS LLC3 | 7920SW 79 TERRACE MIAMI, FL 33143 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $333 | — | $333 | 0.28% |
| LYMAN A. FULTON III3 Filed as: LYMAN A. FULTON | P.O. BOX 628 JOHNSON CITY, TN 37605 | GUARDIAN | $4K | — | $4K | 13.00% |
| LYMAN A. FULTON III3 | PO BOX 628 JOHNSON CITY, TN 37605 | UNITED HEALTHCARE INSURANCE COMPANY | $2K | — | $2K | 8.00% |
| WL PUTNAM AGENCY INC.3 | 77 E 4TH STREET PO BOX 240 DUNKIRK, NY 14048 | MUTUAL OF OMAHA INSURANCE COMPANY | $3K | — | $3K | 12.25% |
| GCG FINANCIAL LLC3 Filed as: DBL GENERAL AGENCY, AN ALERA GROUP | 155 PINELAWN ROAD, STE 120S MELVILLE, NY 11747 | MUTUAL OF OMAHA INSURANCE COMPANY | $1K | — | $1K | 4.97% |
| NATIONAL BENEFITS CENTER LLC3 Filed as: NATIONAL BENEFITS CENTER | 3700 PARK EAST DRIVE, STE 350 BEACHWOOD, OH 44122 | MUTUAL OF OMAHA INSURANCE COMPANY | — | $717 | $717 | 3.04% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUECROSS BLUESHIELD OF TENNESSEE EIN 62-0427913 NONE | Contract Administrator Service code 13 | — | $0 |
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 | 629 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 629 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | 1,108 | $372K |
| Dental | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | 655 | $223K |
| Life insurance(3 contracts, 3 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 502 | $335K |
| Short-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 93 | $24K |
| Long-term disability(3 contracts, 3 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 502 | $238K |
| Other | GUARDIAN | 115 | $33K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,108 | — |
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.