| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS NL LLC | 200 INTERNATIONAL CIRCLE SUITE 4500 HUNT VALLEY, MD 21031 | AMERICAN UNITED LIFE INSURANCE COMPANY | $127K | — | $127K | 12.00% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS NL LLC | — | AMERICAN UNITED LIFE INSURANCE COMPANY | $16K | — | $16K | 1.50% |
| ROBBINS STAR3 | PO BOX 1007 LONDON, KY 40744 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $66K | — | $66K | 9.60% |
| ASSURED NL INS SVCS INC.3 Filed as: ASSURED NL INS AGCY INC | 5905 EAST GALBRAITH ROAD SUITE 500 CINCINNATI, OH 45236 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $34K | — | $34K | 4.99% |
| VMI ACQUISITION INC3 | 109 INTERNATIONAL DRIVE FRANKLIN, TN 37067 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $7K | — | $7K | 1.00% |
| PATTON ROBERT W3 | PO BOX 1007 LONDON, KY 40741 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $879 | — | $879 | 0.13% |
| BRYAN R. BURGESS3 Filed as: BRYAN BURGESS | 1945 SCOTTSVILLE ROAD SUITE 100 BOWLING GREEN, KY 42104 | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | $17K | — | $17K | 2.56% |
| ASSURED BENEFITS INC3 Filed as: ASSURED INSURANCE | 1925 FREDERICA STREET OWENSBORO, KY 42301 | TRUSTMARK INSURANCE COMPANY | $42K | — | $42K | 11.49% |
| STARLENA A ROBBINS3 | 5959 KEAVY ROAD - PO BOX 1007 LONDON, KY 40744 | TRUSTMARK INSURANCE COMPANY | $40K | — | $40K | 10.87% |
| ROBBINS STAR3 Filed as: ROBBINS, STAR | PO BOX 1007 LONDON, KY 40743 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $30K | — | $30K | 14.32% |
| ASSURED NL INS SVCS INC.3 Filed as: ASSURED NL INS AGCY INC | 5905 EAST GALBRAITH ROAD SUITE 5000 CINCINNATI, OH 45236 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $8K | — | $8K | 3.92% |
| FREEMAN, PHILIP3 | 5905 EAST GALBRAITH ROAD SUITE 5000 CINCINNATI, OH 45236 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $5K | — | $5K | 2.22% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUECROSS BLUESHIELD OF TENNESSEE EIN 62-0427913 CLAIMS ADMINISTRATION | Contract Administrator Service code 13 | — | $655K |
| DELTA DENTAL OF TENNESSEE EIN 62-0812197 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $43K |
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 | 1,140 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 42 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,187 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | 2,528 | $674K |
| Vision | EYEMED | 2,456 | $74K |
| Life insurance | AMERICAN UNITED LIFE INSURANCE COMPANY | 1,140 | $1.1M |
| Short-term disability | AMERICAN UNITED LIFE INSURANCE COMPANY | 1,140 | $1.1M |
| Long-term disability | AMERICAN UNITED LIFE INSURANCE COMPANY | 1,140 | $1.1M |
| Other(3 contracts, 2 carriers) | AMERICAN HERITAGE LIFE INSURANCE COMPANY | 827 | $1.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,528 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.