| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | 9648 KINGSTON PIKE STE 8 KNOXVILLE, TN 37922 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | — | $5K | 15.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | 9648 KINGSTON PIKE STE 8 KNOXVILLE, TN 37922 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 15.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | 9648 KINGSTON PIKE STE 8 KNOXVILLE, TN 37922 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 15.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | 9648 KINGSTON PIKE STE 8 KNOXVILLE, TN 37922 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $805 | $11 | $816 | 11.30% |
| SHARON MAY LINDSAY3 | 2911 STAGE RUN DRIVE HIXON, TN 37343 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $184 | $134 | $318 | 4.41% |
| KATHERINE ROBERTS3 | 8846 PICADILLY TRAIL OOLTEWAH, TN 37363 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $253 | $12 | $265 | 3.67% |
| MAX MARTIN LINDSAY3 | 2911 STAGE RUN DRIVE HIXON, TN 37343 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $103 | $64 | $167 | 2.31% |
| VICKIE E LEWIS3 Filed as: VICKIE LEWIS | 6558 STOVALL RD CAVE CITY, KY 42127 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $139 | $26 | $165 | 2.29% |
| DEBRA M DAVIS3 Filed as: DEBRA DAVIS | 6796 MARTHAS PT MEPHIS, TN 38141 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $80 | $0 | $80 | 1.11% |
| HOWARD HOROWITZ3 | 2610 ALCOTT STREET CARMEL, IN 46032 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $42 | $13 | $55 | 0.76% |
| JOHN T ROBERTS3 | 8846 PICADILLY TRAIL OOLTEWAH, TN 37363 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $22 | $0 | $22 | 0.30% |
| BOBBIE J WHITTAKER3 Filed as: BOBBIE WHITTAKER | 2530 SCOTTSVILLE ROAD BOWLING GREEN, KY 42104 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $9 | $0 | $9 | 0.12% |
| J AUSTIN BAKER3 | PO BOX 770941 MEMPHIS, TN 38117 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3 | $2 | $5 | 0.07% |
| SHAWN MARIE KING3 Filed as: SHAWN MARIE DAVIS | 6310 JUPITER AVENUE BARTLETT, TN 38134 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3 | $1 | $4 | 0.06% |
| PARRISH J PEACHEE3 Filed as: PARRISH PEACHEE | 201 W 103RD STREET INDIANAPOLIS, IN 46290 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3 | $0 | $3 | 0.04% |
| LAURA MCCLUNG PLYLER3 Filed as: LAURA CRADDOCK | 6820 COAL CREEK PKWY SE NEW CASTLE, WA 98059 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2 | $1 | $3 | 0.04% |
| EMPLOYEE BENEFIT SOLUTIONS INC3 Filed as: EMPLOYEE BENEFIT SOLUTIONS | 2785 MAYFIELD HWY BENTON, KY 42025 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.03% |
| GREG GRIFFITH3 | 752 WALNUT KNOLL LANE CORDOVA, TN 38018 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2 | $0 | $2 | 0.03% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | 9648 KINGSTON PIKE STE 8 KNOXVILLE, TN 37922 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $625 | — | $625 | 15.00% |
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 | 153 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 153 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 153 | $43K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $11K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 153 | $23K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $4K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 153 | — |
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.