| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TEXAS, INC. | 15305 N DALLAS PKWY ADDISON, TX 75001 | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | $37K | — | $37K | 5.11% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TEXAS INC. | 26 CENTURY BLVD NASHVILLE, TN 37214 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $10K | — | $10K | 15.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TEXAS, INC. | 15305 DALLAS PKWY SUITE 1100 ADDISON, TX 75001 | KAISER FOUNDATION HEALTH PLAN INC. | $3K | — | $3K | 5.30% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TEXAS INC. | 15305 N DALLAS PKWY SUITE 1100, COLONNADE III ADDISON, TX 75001 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 14.79% |
| MACLELLAN, DANIEL, OWEN3 | PO BOX 120548 NASHVILLE, TN 37205 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $239 | $239 | $478 | 3.07% |
| INNIS, KENNETH, STERLING3 Filed as: INNIS, KENNETH, DAVID | PO BOX 120548 NASHVILLE, TN 37212 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $207 | $207 | $414 | 2.66% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS, INC. | 897 12TH ST HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $11 | $28 | $39 | 0.25% |
| THE R.O.W. GROUP3 | 2020 21ST AVE S SUITE 200 NASHVILLE, TN 37212 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.02% |
| INNIS, KENNETH, STERLING3 | 2020 21ST AVE S SUITE 200 NASHVILLE, TN 37212 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.01% |
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 | 127 | 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) | 127 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | 163 | $782K |
| Dental | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | 163 | $717K |
| Vision | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | 163 | $717K |
| Life insurance(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 127 | $81K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 127 | $66K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 127 | $66K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 127 | $81K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 163 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.