| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TYLER MACKIE3 | 208 SUNSET DRIVE JOHNSON CITY, TN 37604 | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | $23K | — | $23K | 4.28% |
| NICHOLAS ANDREW CLAY3 | 801 SUNSET DRIVE, STE 100C JOHNSON CITY, TN 37604 | PRINCIPAL LIFE INSURANCE COMPANY | $4K | — | $4K | 10.14% |
| DAVID WHITAKER | 125 PRITCHARD DR JONESBOROUGH, TN 37659 | AFLAC | $414 | — | $414 | 4.30% |
| EMILY BALDWIN | 491 ROCKINGHAM RD JOHNSON CITY, TN 37615 | AFLAC | $207 | — | $207 | 2.15% |
| MATTIE MULLINS | 904 MILLERCREST DR JOHNSON CITY, TN 37604 | AFLAC | $174 | — | $174 | 1.81% |
| BROWN AND BROWN OF FLORIDA, INC. Filed as: JUDY BROWN | 304 GILDA AVE CHURCH HILL, TN 37642 | AFLAC | $89 | — | $89 | 0.92% |
| RYAN DREBING | 2112 N ROAN ST, SUITE 702 JOHNSON CITY, TN 37601 | AFLAC | $71 | — | $71 | 0.74% |
| JACKSON D RHODES Filed as: JACKSON RHODES | 2332 VOLUNTEER PKWY BRISTOL, TN 37620 | AFLAC | $71 | — | $71 | 0.74% |
| STEVEN BOWLING | 2802 ANITA LN TYLER, TX 75701 | AFLAC | $49 | — | $49 | 0.51% |
| MICHAEL MUSICK | 276 GEORGIA ST BRISTOL, VA 24201 | AFLAC | $48 | — | $48 | 0.50% |
| EMMET HAWKINS | PO BOX 322 ABINGDON, VA 24212 | AFLAC | $45 | — | $45 | 0.47% |
| CHARLES HOUGH | 162 SLATE HILL RD TELFORD, TN 37690 | AFLAC | $44 | — | $44 | 0.46% |
| MELVIN R WARNER Filed as: MELVIN WARNER | 16 GRANDVIEW CT POWDER SPRINGS, GA 30127 | AFLAC | $39 | — | $39 | 0.40% |
| CHARLES F GREER Filed as: CHARLES GREER | 9537 PECKY CYPRESS WAY ORLANDO, FL 32836 | AFLAC | $38 | — | $38 | 0.39% |
| WANDA STEPP | 4720 FOWLER DR MORRISTOWN, TN 37814 | AFLAC | $33 | — | $33 | 0.34% |
| JERRI A SURBER Filed as: JERRI SURBER | 813 WEDGEWOOD RD JOHNSON CITY, TN 37601 | AFLAC | $31 | — | $31 | 0.32% |
| GERALDINE THRIFT | 107 EASTOVER DR GREER, SC 29651 | AFLAC | $31 | — | $31 | 0.32% |
| DAVID R CHARLES Filed as: DAVID CHARLES | 1791 TWIN PINE BLVD GULF BREEZE, FL 32563 | AFLAC | $27 | — | $27 | 0.28% |
| JAMES N TAYLOR Filed as: JAMES TAYLOR | 811 HILL STREET BRISTOL, TN 37620 | AFLAC | $20 | — | $20 | 0.21% |
| RONALD H RICHEY Filed as: RONALD RICHEY | 4023 LAURAWOOD LN FRANKLIN, TN 37067 | AFLAC | $16 | — | $16 | 0.17% |
| KIMBERLY STATEN | PO BOX 8184 GRAY, TN 37615 | AFLAC | $13 | — | $13 | 0.13% |
| THOMAS E HATCHER JR Filed as: THOMAS HATCHER JR | 1588 BAYTREE DR HARRELLS, NC 28444 | AFLAC | $13 | — | $13 | 0.13% |
| RICHARD D HEYDEL | 1921 OLD HICKORY BLVD BRENTWOOD, TN 37027 | AFLAC | $12 | — | $12 | 0.12% |
| ABBIE W COFFMAN Filed as: ABBIE COFFMAN | 31 HAWTHORN CIR CROSSVILLE, TN 38555 | AFLAC | $8 | — | $8 | 0.08% |
| HENRY JUDSON MILLER Filed as: HENRY MILLER | 1112 FAIRGROUNDS CT KINGSTON, TN 37763 | AFLAC | $7 | — | $7 | 0.07% |
| RONALD E KIRKLAND Filed as: RONALD KIRKLAND | 1044 HARBOR RIDGE RD GUNTERSVILLE, AL 35976 | AFLAC | $6 | — | $6 | 0.06% |
| LYNN HODGE | 430 ALFALFA LN JONESBOROUGH, TN 37659 | AFLAC | $5 | — | $5 | 0.05% |
| BRENT GOODE | 2000 GLEN ECHO RD, STE 204 NASHVILLE, TN 37215 | AFLAC | $4 | — | $4 | 0.04% |
| JAMES A SCOTT & SON INC Filed as: JAMES HILL SR | 9701 GAYTON RD, STE 6 RICHMOND, VA 23238 | AFLAC | $2 | — | $2 | 0.02% |
| NICHOLAS ANDREW CLAY3 Filed as: NICHOLAS A CLAY | 801 SUNSET DRIVE, STE 100C JOHNSON CITY, TN 37604 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $147 | — | $147 | 10.01% |
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 | 66 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 66 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | 116 | $542K |
| Dental(2 contracts, 2 carriers) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | 116 | $552K |
| Vision(2 contracts, 2 carriers) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | 116 | $552K |
| Life insurance | AMERICAN GENERAL LIFE INSURANCE COMPANY | 67 | $1K |
| Short-term disability(3 contracts, 3 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 80 | $50K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 80 | $39K |
| Prescription drug | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | 116 | $542K |
| Other | AFLAC | 15 | $10K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 116 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.