| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SEIKO BURKHALTER3 | 3560 LENOX RD STE 2400 ATLANTA, GA 30326 | BLUECROSS BLUESHIELD OF TENNESSEE, INC | $45K | $0 | $45K | 1.98% |
| GROUP INSURANCE SERVICES INC3 | 1 CAMERON HILL CIRCLE 2.5 CHATTANOOGA, TN 37402 | USABLE LIFE | $18K | $0 | $18K | 7.90% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH USA LLC | PO BOX 9375 GREENSBORO, NC 27429 | USABLE LIFE | $3K | $0 | $3K | 1.51% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH USA | 3560 LENOX ROAD NE ATLANTA, GA 30326 | DELTA DENTAL OF TENNESSEE | $4K | $0 | $4K | 4.00% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH USA INC. | PO BOX 28031 NEW YORK, NY 10087 | VISION SERVICE PLAN | $636 | $0 | $636 | 3.28% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH USA | 3560 LENOX ROAD NE ATLANTA, GA 30326 | DELTA DENTAL OF TENNESSEE | $356 | $0 | $356 | 10.00% |
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 | 169 | 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) | 169 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF TENNESSEE, INC | 318 | $2.3M |
| Dental | DELTA DENTAL OF TENNESSEE | 308 | $112K |
| Vision(2 contracts, 2 carriers) | VISION SERVICE PLAN | 296 | $23K |
| Life insurance | USABLE LIFE | 218 | $224K |
| Short-term disability | USABLE LIFE | 218 | $224K |
| Long-term disability | USABLE LIFE | 218 | $224K |
| Other | USABLE LIFE | 218 | $224K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 318 | — |
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.