| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROBERT WALLACE3 | PO BOX 865 CORDOVA, TN 38088 | BLUE CROSS BLUE SHIELD OF TENNESSEE | $18K | — | $18K | 3.94% |
| HERBERT R CHAMBERS3 | 2670 UNION AVENUE EXT STE 200 MEMPHIS, TN 381124434 | BLUE CROSS BLUE SHIELD OF TENNESSEE | $2K | — | $2K | 0.47% |
| ROBERT WALLACE3 | PO BOX 865 CORDOVA, TN 38088 | SUN LIFE ASSURANCE COMPANY OF CANADA | $7K | — | $7K | 8.44% |
| LIPSCOMB & PITTS INSURANCE LLC3 Filed as: LIPSCOMB 7 PITTS INSURANCE LLC | 2670 UNION AVENUE EXT STE 100 MEMPHIS, TN 381124434 | SUN LIFE ASSURANCE COMPANY OF CANADA | $1K | — | $1K | 1.55% |
| GROUP BENEFITS LTD3 Filed as: GROUP BENEFITS LLC | 855 RIDGE LAKE BLVD STE 410 MEMPHIS, TN 381209448 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 9.48% |
| LIPSCOMB & PITTS INSURANCE LLC3 | 2670 UNION AVENUE EXT STE 200 MEMPHIS, TN 381124434 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $149 | — | $149 | 0.52% |
| SEE ATTACHED LIST3 | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $2K | $32 | $2K | 8.35% |
| LIPSCOMB & PITTS INSURANCE LLC3 Filed as: LIPSCOMB & PITTS INS | 2670 UNION AVENUE EXT STE 200 MEMPHIS, TN 381124434 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $675 | — | $675 | 9.99% |
| SEE ATTACHED LIST3 | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $85 | — | $85 | 6.38% |
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 | 218 | 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) | 218 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF TENNESSEE | 218 | $447K |
| Dental | SUN LIFE ASSURANCE COMPANY OF CANADA | 146 | $82K |
| Vision | SUN LIFE ASSURANCE COMPANY OF CANADA | 146 | $82K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 219 | $36K |
| Long-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 219 | $36K |
| Other(4 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 219 | $65K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 219 | — |
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.