| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE BOTTRELL INSURANCE AGENCY3 Filed as: BOTTRELL INSURANCE AGENCY | PO BOX 1490 JACKSON, MS 39215 | HCC LIFE INSURANCE COMPANY | $37K | — | $37K | 7.50% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: FOX EVERETT A DIVISION OF HUB INTER | 300 CONCOURSE BOULEVARD SUITE 300 RIDGELAND, MS 39157 | HCC LIFE INSURANCE COMPANY | $24K | — | $24K | 5.00% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: FISHER BROWN BOTTRELL INSURANCE | PO BOX 1490 JACKSON, MS 39215 | STARMOUNT LIFE INSURANCE COMPANY | $14K | — | $14K | 10.35% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: FISHER BROWN BOTTRELL INSURANCE INC | ACCOUNTING DEPARTMENT PO BOX 1490 JACKSON, MS 39215 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $9K | $2K | $10K | 17.74% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 2.35% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: FISHER BROWN BOTTRELL INSURANCE INC | ACCOUNTING DEPARTMENT PO BOX 1490 JACKSON, MS 39215 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $937 | $5K | 12.36% |
| NATIIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $803 | $803 | 2.03% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: FISHER BROWN BOTTRELL INSURANCE INC | ACCOUNTING DEPARTMENT PO BOX 1490 JACKSON, MS 39215 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $487 | $3K | 17.61% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $417 | $417 | 2.23% |
| JOEL T. ALLEN4 | 544 PAWNEE WAY MADISON, MS 39110 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $2K | — | $2K | 17.31% |
| STAVE BAKER4 | 153 ESTER DRIVE COCOA BEACH, FL 32931 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $421 | — | $421 | 3.06% |
| TERESA M. BURGESS4 | 144 HUNTERS ROW MADISON, MS 39110 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $214 | — | $214 | 1.56% |
| BROOKS WERKHEISER4 | PO BOX 447 PONTE VEDRA BEACH, FL 32004 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $119 | — | $119 | 0.87% |
| TIM C. LEWIS4 | 218 VALLEY RIDGE DRIVE JACKSON, MS 39206 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $93 | — | $93 | 0.68% |
| KEITH E. SMITH4 | 834 BLISSFIELD CHATTANOOGA, TN 37419 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $53 | — | $53 | 0.39% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| FOX EVERETT A DIVSION OF HUB INTERN EIN 35-0672425 CONTRACT ADMINISTRATOR | Claims processing Service code 12 | — | $613K |
| BOTTRELL EIN 64-0887176 BROKER | Custodial (securities) Service code 19 | — | $3K |
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 | 241 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 15 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 258 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | STARMOUNT LIFE INSURANCE COMPANY | 221 | $139K |
| Vision | STARMOUNT LIFE INSURANCE COMPANY | 221 | $139K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 293 | $99K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 97 | $19K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 213 | $490K |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 293 | $113K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 293 | — |
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.