| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| COLE HARRIS3 | 9648 KINGSTONE PARKWAY SUITE 8 KNOXVILLE, TN 37922 | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | $19K | — | $19K | 4.63% |
| ANDY WILLIAMS3 | 2551 GEORGETOWN ROAD NW CLEVELAND, TN 37311 | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | $6K | — | $6K | 1.52% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINATTI, OH 45263 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $7K | $3K | $10K | 15.78% |
| COLE HARRIS3 Filed as: COLE M HARRIS | 9648 KINGSTON PIKE #8 KNOXVILLE, TN 37922 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 3.75% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $22 | $22 | 0.03% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | 721 EMERSON ROAD STE 400 SAINT LOUIS, MO 63141 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 9.95% |
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. | 76 | $406K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 17 | $26K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 17 | $26K |
| Life insurance(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 62 | $93K |
| Short-term disability(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 62 | $93K |
| Long-term disability(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 62 | $93K |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 62 | $93K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 76 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.