| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RUSS BLAKELY & ASSOCIATES LLC3 Filed as: RUSS BLAKELY | P. O. BOX 11310 CHATTANOOGA, TN 37401 | BLUECROSS BLUESHIELD OF TENNESSEE | $63K | $0 | $63K | 5.71% |
| EVERGREEN MANAGEMENT INC3 Filed as: EVERGREEN MANAGEMENT, INC. | 1400 WILLIAMS STREET CHATTANOOGA, TN 374081140 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | $0 | $7K | 4.15% |
| EVERGREEN MANAGEMENT INC3 Filed as: EVERGREEN MANAGEMENT, INC. | 1400 WILLIAMS STREET CHATTANOOGA, TN 374081140 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $0 | $5K | 3.48% |
| EVERGREEN MANAGEMENT INC3 Filed as: EVERGREEN MANAGEMENT, INC. | 1400 WILLIAMS STREET CHATTANOOGA, TN 374081140 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $0 | $4K | 15.75% |
| EVERGREEN MANAGEMENT INC3 Filed as: EVERGREEN MANAGEMENT, INC. | 1400 WILLIAMS STREET CHATTANOOGA, TN 374081140 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $0 | $4K | 15.75% |
| EVERGREEN MANAGEMENT INC3 Filed as: EVERGREEN CONSULTING, INC. | 1400 WILLIAMS STREET CHATTANOOGA, TN 374081140 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 9.92% |
| THE DYER AGENCY3 | P. O. BOX 4160 CHATTANOOGA, TN 37405 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $314 | $0 | $314 | 3.13% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: J. SMITH LANIER & CO. | 1 UNION SQUARE, SUITE 303 CHATTANOOGA, TN 37402 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $26 | $0 | $26 | 0.26% |
| THE DYER AGENCY3 | P. O. BOX 4160 CHATTANOOGA, TN 37405 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $308 | $0 | $308 | 3.99% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: J. SMITH LANIER & CO. | 1 UNION SQUARE, SUITE 303 CHATTANOOGA, TN 37402 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $105 | $0 | $105 | 1.36% |
| OEHMIG, WILLIAM, BRIT3 | P. O. BOX 2587 CHATTANOOGA, TN 37409 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $357 | $0 | $357 | 10.00% |
| JACK B TURNER3 Filed as: JACK B. TURNER & ASSOCIATES, INC. | P. O. BOX 627 CLARKSVILLE, TN 37041 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $143 | $0 | $143 | 4.01% |
| MEDICAL GROUP INSURANCE SERVICES5 | 1849 WEST NORTH TEMPLE SALT LAKE CITY, UT 84116 | SUN LIFE ASSURANCE COMPANY OF CANADA | $0 | $60 | $60 | 3.72% |
| MGIS3 Filed as: MGIS, INC. | 1849 WEST NORTH TEMPLE SALT LAKE CITY, UT 84116 | SUN LIFE ASSURANCE COMPANY OF CANADA | $37 | $0 | $37 | 2.30% |
| TOM JOHNSON3 | 3800 COLONNADE PARKWAY, SUITE 540 BIRMINGHAM, AL 352433367 | SUN LIFE ASSURANCE COMPANY OF CANADA | $4 | $0 | $4 | 0.25% |
| RUSS BLAKELY & ASSOCIATES LLC3 Filed as: RUSS BLAKELY | P. O. BOX 11310 CHATTANOOGA, TN 37401 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $157 | $0 | $157 | 15.02% |
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 | 213 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 215 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF TENNESSEE | 242 | $1.1M |
| Dental | BLUECROSS BLUESHIELD OF TENNESSEE | 242 | $1.1M |
| Life insurance(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 214 | $183K |
| Short-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 34 | $31K |
| Long-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 208 | $170K |
| Other(5 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 238 | $218K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 242 | — |
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.