| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EDWARD SIMS3 | PO BOX 10328 KNOXVILLE, TN 37939 | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | $44K | $0 | $44K | 6.26% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: TIS INSURANCE SERVICES INC | 1900 N WINSTON RD STE 100 KNOXVILLE, TN 37919 | AMERITAS LIFE INSURANCE CORP. | $5K | $0 | $5K | 5.88% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SVCS INC | 700 W 47TH ST STE 1100 KANSAS CITY, MA 64112 | AMERITAS LIFE INSURANCE CORP. | -$3 | $0 | -$3 | -0.00% |
| GROUP INSURANCE SERVICES INC3 | 1 CAMERON HILL CIRCLE CHATTANOOGA, TN 37402 | SYMETRA LIFE INSURANCE COMPANY | $0 | $2K | $2K | 8.34% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: TIS INSURANCE SERVICES | 1900 N WINSTON RD STE 100 KNOXVILLE, TN 37919 | AMERICAN UNITED LIFE INSURANCE COMPANY | $2K | $0 | $2K | 8.67% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SVCS | 264 NORTH OCOEE SUITE 202 CLEVELAND, TN 37311 | AMERICAN UNITED LIFE INSURANCE COMPANY | $226 | $0 | $226 | 0.85% |
| EMPLOYEE FAMILY PROTECTION INC3 Filed as: EMPLOYEE FAMILY PROTECTION INC. | PO BOX 1237 GLASTONBURY, CT 06033 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $220 | $2K | 18.85% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: TIS INSURANCE SERVICES INC | 1900 N WINSTON RD #100 PO BOX 10328 KNOXVILLE, TN 37919 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $810 | $31 | $841 | 7.52% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: TIS INSURANCE SERVICES INC | 1900 WINSTON RD SUITE 100 KNOXVILLE, TN 37919 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 18.00% |
| THE MATHIS-HILL-ROBERTSON AGENCY3 Filed as: THE MATHIS-HILL-ROBERTSON AGEN | 5040 ROSEWELL RD ATLANTA, GA 30342 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $107 | $0 | $107 | 1.12% |
| EMPLOYEE FAMILY PROTECTION INC3 Filed as: EMPLOYEE FAMILY PROTECTION INC. | PO BOX 1237 GLASTONBURY, CT 06033 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $186 | $0 | $186 | 3.51% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: TIS INSURANCE SERVICES INC | 1900 N WINSTON RD #100 PO BOX 10328 KNOXVILLE, TN 37919 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $80 | $0 | $80 | 1.51% |
| BENEFIT ADVISORS NETWORK LLC3 Filed as: BENEFIT ADVISORS NETWORK | 6830 COCHRAN RD SOLON, OH 44139 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $0 | $74 | $74 | 1.39% |
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 | 286 | 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) | 286 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | 129 | $732K |
| Dental | AMERITAS LIFE INSURANCE CORP. | 303 | $80K |
| Vision | AMERITAS LIFE INSURANCE CORP. | 303 | $80K |
| Life insurance(2 contracts, 2 carriers) | AMERICAN UNITED LIFE INSURANCE COMPANY | 286 | $32K |
| Other(5 contracts, 5 carriers) | AMERITAS LIFE INSURANCE CORP. | 303 | $133K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 303 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.