| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EDWARD R. HOWELL3 | PO BOX 158548 NASHVILLE, TN 37215 | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | $14K | — | $14K | 0.26% |
| GROUP BENEFIT SYSTEM INC.3 | 992 DAVIDSON DR STE 108 NASHVILLE, TN 37205 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $25K | — | $25K | 7.09% |
| EXCALIBUR FINANCIAL GROUP3 | 302 KNIGHTS RUN AVE STE 1000 TAMPA, FL 33602 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $10K | — | $10K | 2.91% |
| GROUP BENEFIT SYSTEMS INC3 Filed as: GROUP BENEFIT SYSTEMS, INC. | PO BOX 158548 NASHVILLE, TN 37205 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | — | $5K | 2.82% |
| EXCALIBUR FINANCIAL GROUP3 | 302 KNIGHTS RUN AVE STE 1000 TAMPA, FL 33602 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $788 | — | $788 | 0.41% |
| GROUP BENEFIT SYSTEM INC.3 | 992 DAVIDSON DR STE 108 NASHVILLE, TN 37205 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | — | $5K | 3.30% |
| EXCALIBUR FINANCIAL GROUP3 | 302 KNIGHTS RUN AVE STE 1000 TAMPA, FL 33602 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $453 | — | $453 | 0.29% |
| GROUP BENEFIT SYSTEM INC.3 | 992 DAVIDSON DR STE 108 NASHVILLE, TN 37205 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 5.58% |
| EXCALIBUR FINANCIAL GROUP3 | 302 KNIGHTS RUN AVE STE 1000 TAMPA, FL 33602 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $526 | — | $526 | 0.73% |
| GROUP BENEFIT SYSTEM INC.3 | 992 DAVIDSON DR STE 108 NASHVILLE, TN 37205 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | — | $6K | 9.25% |
| EXCALIBUR FINANCIAL GROUP3 | 302 KNIGHTS RUN AVE STE 1000 TAMPA, FL 33602 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 1.47% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: SEITLIN, MARSH & MCLENNAN AGENCY | 9850 NW 41ST ST. SUITE 100 MIAMI, FL 33178 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $5K | — | $5K | 10.34% |
| GROUP BENEFIT SYSTEM INC.3 | 992 DAVIDSON DR STE 108 NASHVILLE, TN 37205 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | — | $6K | 14.51% |
| EXCALIBUR FINANCIAL GROUP3 | 302 KNIGHTS RUN AVE STE 1000 TAMPA, FL 33602 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 5.49% |
| GROUP BENEFIT SYSTEM INC.3 | 992 DAVIDSON DR STE 108 NASHVILLE, TN 37205 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | — | $5K | 14.45% |
| EXCALIBUR FINANCIAL GROUP3 | 302 KNIGHTS RUN AVE STE 1000 TAMPA, FL 33602 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 5.55% |
| GROUP BENEFIT SYSTEM INC.3 | 992 DAVIDSON DR STE 108 NASHVILLE, TN 37205 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 14.27% |
| EXCALIBUR FINANCIAL GROUP3 | 302 KNIGHTS RUN AVE STE 1000 TAMPA, FL 33602 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 5.73% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| GROUP BENEFIT SYSTEMS, INC. EIN 62-1020448 INSURANCE BROKER | Insurance agents and brokers Service code 22 | PO BOX 158548 NASHVILLE, TN 37215 | $40K |
| EXCALIBUR FINANCIAL GROUP EIN 47-0322111 | Insurance agents and brokers Service code 22 | 302 KNIGHTS RUN AVE STE 1000 TAMPTA, FL 33602 | $0 |
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 | 359 | 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) | 359 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | 765 | $5.4M |
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 403 | $353K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 684 | $46K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 534 | $142K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 535 | $190K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 535 | $154K |
| Other(4 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 534 | $207K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 765 | — |
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.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.