| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ANITA BLACKMER3 | 3011 ARMORY DR., STE. 250 NASHVILLE, TN 37204 | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | $26K | — | $26K | 4.46% |
| CRICHTON BRANDON JACKSON3 | PO BOX 306015 NASHVILLE, TN 372306015 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | — | $2K | 15.00% |
| CRICHTON BRANDON JACKSON3 Filed as: CRICHTON BRANDON & JACKSON | PO BOX 306015 NASHVILLE, TN 37230 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $439 | $23 | $462 | 9.54% |
| DEBBIE PERKINS3 | 9655 BRUNSWICK DRIVE BRENTWOOD, TN 37027 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $220 | $21 | $241 | 4.98% |
| MELISSA MARIE HURLEY3 Filed as: MELISSA SUE JONES | 3222 MOOREHEAD DR. NASHVILLE, TN 37207 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $104 | — | $104 | 2.15% |
| SHELIA A SHELL3 | 413 MOSS TRAIL GOODLETTSVILLE, TN 37072 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $83 | $6 | $89 | 1.84% |
| MITZI FARLEY3 | 112 SPRINGFIELD DR. SMYRNA, TN 37167 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $26 | $38 | $64 | 1.32% |
| LISA JENNETTE UNDERHILL3 Filed as: LISA JEANETTE UNDERHILL | 1296 RED OAK DR BRENTWOOD, TN 37027 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $51 | $2 | $53 | 1.09% |
| MARK A SHELL3 | 413 MOSS TRAIL GOODLETTSVILLE, TN 37072 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $19 | — | $19 | 0.39% |
| DEBBIE R CUNNINGHAM3 | 4006 WINDSONG TRAIL GREENBRIER, TN 37073 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | — | $9 | 0.19% |
| LERMAN VENTURES INC3 Filed as: LERMAN VENTURES, INC. | 2985 SURREY RIDGE RD CLARKSVILLE, TN 37043 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | $1 | $4 | 0.08% |
| CRICHTON BRANDON JACKSON & WARD INC3 | PO BOX 306015 NASHVILLE, TN 37230 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $224 | $12 | $236 | 9.82% |
| MITZI FARLEY3 | 112 SPRINGFIELD DR. SMYRNA, TN 37167 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $86 | $123 | $209 | 8.70% |
| DEBBIE PERKINS3 | 9655 BRUNSWICK DRIVE BRENTWOOD, TN 37027 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $105 | $10 | $115 | 4.79% |
| SHELIA A SHELL3 | 413 MOSS TRAIL GOODLETTSVILLE, TN 37072 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $43 | $3 | $46 | 1.91% |
| LISA JENNETTE UNDERHILL3 Filed as: LISA JEANETTE UNDERHILL | 1296 RED OAK DR. BRENTWOOD, TN 37027 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $32 | $0 | $32 | 1.33% |
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | 229 | $574K |
| Dental | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | 229 | $574K |
| Vision | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | 229 | $574K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 152 | $12K |
| Short-term disability(2 contracts) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 13 | $7K |
| Other(3 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 152 | $19K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 229 | — |
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.