| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JENNIFER RETAMAR3 | 13901 SUTTON PARK DRIVE SOUTH BUILDING C, SUITE 360 JACKSONVILLE, FL 32224 | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | $6K | $0 | $6K | 0.74% |
| ENERGY INSURANCE AGENCY INC3 Filed as: ENERGY INSURANCE AGENCY, INC. | 3008 ATKINSON AVENUE LEXINGTON, KY 40509 | AMERICAN UNITED LIFE INSURANCE COMPANY | $12K | $0 | $12K | 14.32% |
| 4MYBENEFITS, INC.3 | UNKNOWN ALEXANDRIA, VA 22312 | AMERICAN UNITED LIFE INSURANCE COMPANY | $0 | $4K | $4K | 4.47% |
| ANNE T. ALTIERI3 | 3008 ATKINSON AVENUE LEXINGTON, KY 40509 | AETNA LIFE INSURANCE COMPANY | $7K | $0 | $7K | 9.64% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 4000 MIDLANTIC DRIVE MOUNT LAUREL, NJ 08054 | AETNA LIFE INSURANCE COMPANY | $197 | $698 | $895 | 1.20% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 4000 MIDLANTIC AVENUE MOUNT LAUREL, NJ 08054 | AETNA LIFE INSURANCE COMPANY | $716 | $0 | $716 | 0.96% |
| PLANSOURCE BENEFITS ADMINISTRATION3 Filed as: PLANSOURCE HOLDINGS, INC. | 101 SOUTH GARLAND AVENUE SUITE 203 ORLANDO, FL 32801 | AETNA LIFE INSURANCE COMPANY | -$5 | $0 | -$5 | -0.01% |
| ENERGY INSURANCE AGENCY INC3 Filed as: ENERGY INSURANCE AGENCY, INC. | 3008 ATKINSON AVENUE LEXINGTON, KY 40509 | HARTFORD LIFE AND ACCIDENT | $5K | $0 | $5K | 19.97% |
| ENERGY INSURANCE AGENCY INC4 Filed as: ENERGY INSURANCE AGENCY | 3008 ATKINSON AVENUE LEXINGTON, KY 40509 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $5K | $0 | $5K | 27.81% |
| PRENSIA L. RICHARD4 | 116 KENBRIDGE LANE MADISON, MS 39110 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $17 | $0 | $17 | 0.09% |
| DALENE SAWYER4 | 14926 GABLES END DRIVE ATHENS, AL 35613 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $13 | $0 | $13 | 0.07% |
| ENERGY INSURANCE AGENCY INC3 Filed as: ENERGY INSURANCE AGENCY, INC. | PO BOX 55268 LEXINGTON, KY 04055 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $746 | $0 | $746 | 9.98% |
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 | 1,371 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 460 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,831 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | 1,996 | $842K |
| Dental | AETNA LIFE INSURANCE COMPANY | 1,996 | $75K |
| Vision(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 1,996 | $82K |
| Life insurance(2 contracts, 2 carriers) | AMERICAN UNITED LIFE INSURANCE COMPANY | 1,996 | $156K |
| Short-term disability | AMERICAN UNITED LIFE INSURANCE COMPANY | 892 | $82K |
| Long-term disability | AMERICAN UNITED LIFE INSURANCE COMPANY | 892 | $82K |
| Prescription drug(2 contracts, 2 carriers) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | 1,996 | $842K |
| Other(4 contracts, 4 carriers) | AMERICAN UNITED LIFE INSURANCE COMPANY | 1,996 | $200K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,996 | — |
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.