| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| XEBEC MANAGEMENT INC.3 Filed as: XEBEC MANAGEMENT INC | 618 CHURCH ST SUITE 220 NASHVILLE, TN 37219 | UNITEDHEALTH CARE INSURANCE COMPANY | $6K | $66K | $72K | 3.61% |
| IMA, INC.3 | 1705 17TH STREET SUITE 100 DENVER, CO 80202 | UNITEDHEALTH CARE INSURANCE COMPANY | $1K | — | $1K | 0.07% |
| XMI HOLDINGS3 Filed as: XMI ACQUISITION, LLC | 618 CHURCH STREET SUITE 250 NASHVILLE, TN 37219 | UNITEDHEALTH CARE INSURANCE COMPANY | $426 | — | $426 | 0.02% |
| JAMES HUTTON3 | 1020 MONTROSE DR. GALLATIN, TN 37066 | AFLAC | $2K | $330 | $2K | 6.67% |
| XMI HOLDINGS3 Filed as: XMI HOLDINGS INC. | 618 CHURCH ST SUITE 220 NASHVILLE, TN 37219 | AFLAC | $903 | — | $903 | 3.03% |
| KELSEY DAVID EVERT3 | 2055 N MOUNT JULIET RD. SUITE 201 MOUNT JULIET, TN 37122 | AFLAC | $555 | $94 | $649 | 2.18% |
| NOLAN DOYLE MCCUE3 | 242 HERITAGE PARK DR. SUITE 108 MURFREESBORO, TN 37129 | AFLAC | $336 | $86 | $422 | 1.42% |
| ROBERT EDWARD HARDWICK3 | 120 LAKEWOOD DR. CROSSVILLE, TN 38558 | AFLAC | $242 | — | $242 | 0.81% |
| MARIAN E HENDERSON3 Filed as: MARIAN HENDERSON | 102 SAVANNAH WAY HENDERSONVILLE, TN 37075 | AFLAC | $108 | $89 | $197 | 0.66% |
| CHRISTOPHER R MORRIS3 Filed as: CHRISTOPHER RICHARDSON | 103 CHEROKEE BLVD. CHATTANOOGA, TN 37405 | AFLAC | $96 | $58 | $154 | 0.52% |
| LARA K GRANDE3 Filed as: LARA K. GRANDE | 1022 WESTHAVEN BLVD. FRANKLIN, TN 37064 | AFLAC | $92 | $12 | $104 | 0.35% |
| CHARLES HARTHUN3 | 1577 LAWSON RD. CROSSVILLE, TN 38571 | AFLAC | $91 | $9 | $100 | 0.34% |
| MITCHELL LILLY3 | 1187 DISNEYLAND RD SPARTA, TN 38583 | AFLAC | $74 | — | $74 | 0.25% |
| ERIC ANGIS3 | 910 SAINT ANDREWS DR. APT 112 MURFREESBORO, TN 37128 | AFLAC | $29 | $39 | $68 | 0.23% |
| LORI R GRIZZELL3 Filed as: LORI GRIZZELL | 1069 S. HEWITT RD. BOWLING GREEN, KY 42103 | AFLAC | $28 | $40 | $68 | 0.23% |
| DEBORAH WALKER HULETTE3 | 115 CARRIAGE CV EADS, TN 38028 | AFLAC | $29 | $29 | $58 | 0.19% |
| KRISTIN LATTRELL3 Filed as: KRISTIN LEE LATTREL | 908 N 14TH ST. NASHVILLE, TN 37206 | AFLAC | $54 | — | $54 | 0.18% |
| BRENT GOODE3 | 200 GLEN ECHO RD. SUITE 204 NASHVILLE, TN 37215 | AFLAC | $43 | — | $43 | 0.14% |
| EMMETT HAWKINS3 | P.O. BOX 322 ABINGDON, VA 24212 | AFLAC | $40 | — | $40 | 0.13% |
| MILTON E WUERTZ3 Filed as: MILTON WUERTZ | 1017 BELMONT DR. DICKSON, TN 37055 | AFLAC | $33 | — | $33 | 0.11% |
| CHARLES HARTHUN3 | 105 CASSIDY PLACE CROSSVILLE, TN 38555 | AFLAC | $29 | — | $29 | 0.10% |
| WAYNE G MCMEEN3 Filed as: WAYNE MCMEEN | 7902 COVE RIDGE DR. HIXSON, TN 37343 | AFLAC | $18 | $10 | $28 | 0.09% |
| TIMOTHY CLENNEY3 | PO BOX 562 PARSONS, TN 38363 | AFLAC | $16 | $7 | $23 | 0.08% |
| THOMAS WILLIAMSON3 | 88 ABBEY RD. LEBANON, TN 37090 | AFLAC | $17 | $3 | $20 | 0.07% |
| JAMES BURTON3 | 5470 KINGS HILL DR. CUMMING, GA 30040 | AFLAC | $19 | — | $19 | 0.06% |
| MATTHEW SMITH3 | 11829 OLDEGROVE PL. TAMPA, FL 33617 | AFLAC | $11 | $8 | $19 | 0.06% |
| GEORGE SEYMOUR3 | 1007 LAURELWOOD DR. KINGSPORT, TN 37660 | AFLAC | $10 | $8 | $18 | 0.06% |
| JAMES D DUDLEY3 Filed as: JAMES DUDLEY | 1355 LYNNFIELD DR. MEMPHIS, TN 38119 | AFLAC | $11 | $6 | $17 | 0.06% |
| HOWARD EATON3 | 1377 CARMONY ST. COLLIERVILLE, TN 38017 | AFLAC | $9 | $6 | $15 | 0.05% |
| JAY OLEARY3 | 2000 GLEN ECHO RD STE 204 NASHVILLE, TN 37215 | AFLAC | $14 | — | $14 | 0.05% |
| JOSEPH LEDOUX3 | 2411 CARTER AVE NASHVILLE, TN 37206 | AFLAC | $14 | — | $14 | 0.05% |
| ROBERT FISH3 | 450 PARK PLACE CT. SUWANNE, GA 30024 | AFLAC | $11 | — | $11 | 0.04% |
| JACKSON D RHODES3 Filed as: JACKSON RHODES | 525 W OAKLAND AVE SUITE 7 JOHNSON CITY, TN 37604 | AFLAC | $8 | $1 | $9 | 0.03% |
| MARK WAYNE SPRADLING3 | 4505 PINE TREE CIRCLE STE 201 VESTAVIA, AL 35243 | AFLAC | $4 | $4 | $8 | 0.03% |
| TONYA LANCASTER3 | 1820 THE EXCHANGE SE STE 750 ATLANTA, GA 30339 | AFLAC | $5 | — | $5 | 0.02% |
| STEVEN BREWER3 | 715 PINE RIDGE RD. LEXINGTON, TN 38351 | AFLAC | $4 | $1 | $5 | 0.02% |
| VBTN, INC3 Filed as: VBTN INC. | 2000 GLEN ECHO RD. SUITE 204 NASHVILLE, TN 37215 | AFLAC | $4 | — | $4 | 0.01% |
| SCOTT A SMITH3 Filed as: SCOTT SMITH | 5300 OAKBROOK PKWY STE 300 NORCROSS, GA 30093 | AFLAC | $2 | — | $2 | 0.01% |
| MATTHEW D BUTLER3 Filed as: MATTHEW BUTLER | 123 CENTER PARK DR. SUITE 102 KNOXVILLE, TN 37922 | AFLAC | $2 | — | $2 | 0.01% |
| XMI HOLDINGS3 Filed as: XMI ACQUISITION LLC | 618 CHURCH ST SUITE 520 NASHVILLE, TN 37219 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $1K | — | $1K | 10.00% |
| IMA, INC.3 Filed as: IMA INC. | PO BOX 2992 WICHITA, KS 67201 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $177 | — | $177 | 1.52% |
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 | 597 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 597 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTH CARE INSURANCE COMPANY | 597 | $2.0M |
| Dental | UNITEDHEALTH CARE INSURANCE COMPANY | 597 | $2.0M |
| Vision | UNITEDHEALTH CARE INSURANCE COMPANY | 597 | $2.0M |
| Life insurance | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 504 | $12K |
| Short-term disability | AFLAC | 36 | $30K |
| Other(2 contracts, 2 carriers) | AFLAC | 504 | $41K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 597 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.