| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EDWARD SIMS3 | P.O. BOX 10328 KNOXVILLE, TN 37939 | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | $25K | — | $25K | 3.30% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: TIS INSURANCE SERVICES INC | 1900 WINSTON ROAD SUITE 100 KNOXVILLE, TN 37919 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $9K | $6K | $15K | 12.10% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: TIS INSURANCE SERVICES INC | WINSTON ROAD BUSINESS CENTER KNOXVILLE, TN 37919 | SYMETRA FINANCIAL | $5K | — | $5K | 10.32% |
| GROUP INSURANCE SERVICES INC3 | 1 CAMERON HILL CIRCLE CHATTANOOGA, TN 37402 | SYMETRA FINANCIAL | — | $2K | $2K | 3.30% |
No Schedule C service providers reported on this filing.
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 | 246 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 221 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 467 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | 119 | $772K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 299 | $124K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 299 | $124K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 299 | $124K |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 299 | $171K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 299 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.