| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| VARIOUS - SEE ATTACHED3 Filed as: VARIOUS SEE ATTACHED. | — | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $505K | $68K | $573K | 18.52% |
| JEFFREY C. LYNCH3 Filed as: JEFFREY LYNCH | 783 OLD HICKORY BLVD. BRENTWOOD, TN 37027 | RELIANCE STANDARD | $39K | — | $39K | 2.00% |
| JEFFREY C. LYNCH3 Filed as: JEFFREY LYNCH | 783 OLD HICKORY BLVD. STE 201 BRENTWOOD, TN 370274508 | RELIANCE STANDARD | $116K | — | $116K | 7.00% |
| JEFFREY C. LYNCH Filed as: JEFFREY LYNCH | 783 OLD HICKORY BLVD. BRENTWOOD, TN 37027 | VSP | $13K | — | $13K | 0.86% |
| JEFFREY C. LYNCH3 Filed as: JEFFREY LYNCH | 783 OLD HICKORY BLVD. BRENTWOOD, TN 370274508 | RELIANCE STANDARD | $5K | — | $5K | 2.00% |
| JEFFREY C. LYNCH3 Filed as: JEFFREY LYNCH | 783 OLD HICKORY BLVD. BRENTWOOD, TN 37027 | RELIANCE STANDARD | $2K | — | $2K | 2.00% |
| JEFFREY C. LYNCH3 Filed as: JEFFREY LYNCH | 783 OLD HICKORY BLVD. BRENTWOOD, TN 37027 | RELIANCE STANDARD | $1K | — | $1K | 2.00% |
| JEFFREY C. LYNCH3 Filed as: JEFFREY LYNCH | 783 OLD HICKORY BLVD. BRENTWOOD, TN 37027 | DELTA DENTAL OF TENNESSEE | $20K | — | $20K | — |
| SUMMIT FINANCIAL GROUP INC.3 Filed as: SUMMIT FINANCIAL GROUP | 783 OLD HICKORY BLVD. BRENTWOOD, TN 37027 | DELTA DENTAL OF TENNESSEE | $2K | — | $2K | — |
| JEFFREY C. LYNCH3 Filed as: JEFFREY LYNCH | 783 OLD HICKORY BLVD. BRENTWOOD, TN 37027 | CIGNA HEALTH AND LIFE INSURANCE COMPANY (CIGNA) | $69K | — | $69K | — |
| JEFFREY C. LYNCH3 Filed as: JEFFREY LYNCH | 783 OLD HICKORY BLVD. BRENTWOOD, TN 37027 | BLUECROSS BLUESHIELD OF TENNESSEE | $17K | — | $17K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 CLAIM ADMINISTRATION | Participant communication; Other services; Contract Administrator; Non-monetary compensation; Named fiduciary; Float revenue; Direct payment from the plan; Claims processing Service code 12 | — | $3.7M |
| BLUECROSS BLUESHIELD OF TN EIN 62-0427913 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 1 CAMERON HILL CIRCLE CHATTANOOGA, TN 37402 | $1.3M |
| DELTA DENTAL OF TENNESSEE EIN 62-0812197 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 240 VENTURE CIRCLE NASHVILLE, TN 37228 | $251K |
| CIGNA BEHAVIORAL HEALTH,INC EIN 41-1648670 ADMIN EMP ASSIST PLAN | Claims processing; Participant communication; Contract Administrator; Direct payment from the plan Service code 12 | — | $129K |
| EXPRESS SCRIPTS, INC EIN 87-0548860 PHARMACY BENEFIT MANAGER | Claims processing Service code 12 | ONE EXPRESS WAY ST LOUIS, MO 63121 | $33K |
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 | 16,430 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 16,430 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY (CIGNA) | 11,735 | $0 |
| Dental | DELTA DENTAL OF TENNESSEE | 17,281 | $0 |
| Vision | VSP | 6,540 | $1.5M |
| Life insurance | RELIANCE STANDARD | 7,012 | $1.9M |
| Long-term disability(2 contracts) | RELIANCE STANDARD | 2,774 | $1.9M |
| Prescription drug | EXPRESS SCRIPTS, INC. | 16,430 | $0 |
| Stop-loss / reinsurancereinsurance | BLUECROSS BLUESHIELD OF TENNESSEE | 0 | $0 |
| Other(2 contracts) | RELIANCE STANDARD | 7,108 | $167K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 17,281 | — |
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.