| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROBERT A LEVY3 Filed as: ROBERT A. LEVY | 20 GALLERIA PARKWAY, SUITE 1950 ATLANTA, GA 30339 | BLUE CROSS BLUE SHIELD OF TENNESSEE, INC. | $26K | $0 | $26K | 2.57% |
| NICOLE JONES GYLLSTROM3 | 1255 BATTERY STREET, SUITE 450 SAN FRANCISCO, CA 94111 | BLUE CROSS BLUE SHIELD OF TENNESSEE, INC. | $13K | $0 | $13K | 1.25% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 9515 HILLWOOD DRIVE LAS VEGAS, NV 89134 | DELTA DENTAL OF TENNESSEE | $2K | $0 | $2K | 3.44% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE | 200 GALLERIA PARKWAY, SUITE 1950 ATLANTA, GA 30339 | DELTA DENTAL OF TENNESSEE | $2K | $0 | $2K | 3.06% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 1255 BATTERY STREET, SUITE 450 SAN FRANCISCO, CA 94111 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $0 | $4K | 9.48% |
| PARADIGM GROUP3 Filed as: PARADIGM GROUP, LLC | 1600 DIVISION STREET, SUITE 220 NASHVILLE, TN 37203 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 4.36% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $924 | $924 | 2.49% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE, LLC | 200 GALLERIA PARKWAY, SUITE 1950 ATLANTA, GA 30339 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $479 | $0 | $479 | 1.29% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE, LLC | 200 GALLERIA PARKWAY, SUITE 1950 ATLANTA, GA 30339 | USABLE LIFE | $747 | $113 | $860 | 10.33% |
| GROUP INSURANCE SERVICES INC3 Filed as: GROUP INSURANCE SERVICES, INC. | 1 CAMERON HILL CIRCLE 2.5 CHATTANOOGA, TN 37402 | USABLE LIFE | $782 | $0 | $782 | 9.39% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 3600 AMERICAN BOULEVARD WEST SUITE 500 BLOOMINGTON, MN 55431 | USABLE LIFE | $473 | $0 | $473 | 5.68% |
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 | 186 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 34 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 223 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF TENNESSEE, INC. | 205 | $1.0M |
| Dental | DELTA DENTAL OF TENNESSEE | 186 | $65K |
| Vision | BLUE CROSS BLUE SHIELD OF TENNESSEE, INC. | 205 | $1.0M |
| Life insurance(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 63 | $45K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 63 | $37K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF TENNESSEE, INC. | 205 | $1.0M |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 63 | $45K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 205 | — |
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.