| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MONROE D FORD3 | PO BOX 161 WHITE BLUFF, TN 37187 | BLUECROSS BLUESHIELD OF TENNESSEE, INC | $41K | — | $41K | 5.64% |
| DAVID FORD | PO BOX 161 WHITE BLUFF, TN 37187 | USABLE LIFE | $8K | — | $8K | 15.00% |
| GROUP INSURANCE SERVICES INC Filed as: GROUP INSURANCE SERVICES | 1 CAMERON HILL CIRCLE - 2.5 CHATTANOOGA, TN 37402 | USABLE LIFE | $914 | $1K | $2K | 3.66% |
| DAVID FORD3 Filed as: DAVID MONROE FORD, PETER CALABRESE | PO BOX 161 WHITE BLUFF, TN 37187 | ASSURITY LIFE INSURANCE COMPANY | $7K | — | $7K | 22.84% |
| DAVID FORD3 Filed as: DAVID M FORD | PO BOX 161 WHITE BLUFF, TN 37187 | COMPANION LIFE | $3K | — | $3K | 9.66% |
| GROUP INSURANCE SERVICES INC3 Filed as: GROUP INSURANCE SERVICES | 1 CAMERON HILL CIRCLE - 2.5 CHATTANOOGA, TN 37402 | COMPANION LIFE | $2K | — | $2K | 4.83% |
| DAVID FORD | PO BOX 161 WHITE BLUFF, TN 37187 | USABLE LIFE | $4K | — | $4K | 15.00% |
| GROUP INSURANCE SERVICES INC Filed as: GROUP INSURANCE SERVICES | 1 CAMERON HILL CIRCLE - 2.5 CHATTANOOGA, TN 37402 | USABLE LIFE | $557 | $485 | $1K | 4.30% |
| DAVID FORD | PO BOX 161 WHITE BLUFF, TN 37187 | USABLE LIFE | $3K | — | $3K | 15.00% |
| GROUP INSURANCE SERVICES INC Filed as: GROUP INSURANCE SERVICES | 1 CAMERON HILL CIRCLE - 2.5 CHATTANOOGA, TN 37402 | USABLE LIFE | $3K | — | $3K | 15.00% |
| DAVID FORD | PO BOX 161 WHITE BLUFF, TN 37187 | USABLE LIFE | $2K | — | $2K | 15.00% |
| GROUP INSURANCE SERVICES INC Filed as: GROUP INSURANCE SERVICES | 1 CAMERON HILL CIRCLE - 2.5 CHATTANOOGA, TN 37402 | USABLE LIFE | $2K | — | $2K | 15.00% |
| DAVID FORD3 Filed as: DAVID M FORD | PO BOX 161 WHITE BLUFF, TN 37187 | COMPANION LIFE | $1K | — | $1K | 9.66% |
| GROUP INSURANCE SERVICES INC3 Filed as: GROUP INSURANCE SERVICES | 1 CAMERON HILL CIRCLE - 2.5 CHATTANOOGA, TN 37402 | COMPANION LIFE | $591 | — | $591 | 4.83% |
| DAVID FORD3 Filed as: DAVID MONROE FORD | PO BOX 161 WHITE BLUFF, TN 37187 | AFLAC | $115 | — | $115 | 1.61% |
| DAVID M CRUMLEY3 Filed as: DAVID E WATSON | PO BOX 3094 BRENTWOOD, TN 37024 | AFLAC | $115 | — | $115 | 1.61% |
| GEORGE W HURST III3 | 7146 LAKEVIEW CT BRENTWOOD, TN 37027 | AFLAC | $107 | — | $107 | 1.50% |
| KANDI M MCINTYRE3 | 2000 MALLORY LN STE 130-378 FRANKLIN, TN 37067 | AFLAC | $62 | — | $62 | 0.87% |
| KERI D PHILLIPS3 | 2004 RAVEN DR HERMITAGE, TN 37076 | AFLAC | $53 | — | $53 | 0.74% |
| BRIAN LARSON3 Filed as: BRIAN D LARSON | 883 FORD ST ALCOA, TN 37701 | AFLAC | $43 | — | $43 | 0.60% |
| BARRY DOUGLAS DILLARD3 | 62 GRANT HWY GORDONSVILLE, TN 38563 | AFLAC | $31 | — | $31 | 0.43% |
| ROBERT L GOBLE3 | 1410 4TH STREET DR NW UNIT 208 HICKORY, NC 28601 | AFLAC | $29 | — | $29 | 0.41% |
| ABBIE W COFFMAN3 Filed as: ABBIE COFFMAN | 31 HAWTHORN CIR CROSSVILLE, TN 38555 | AFLAC | $23 | — | $23 | 0.32% |
| ROBERT M FUDGE3 | 2617 CHURCHILL DR THOMPSONS STATION, TN 37179 | AFLAC | $22 | — | $22 | 0.31% |
| DONALD L LARSON3 | 1528 LOUISVILLE RD ALCOA, TN 37701 | AFLAC | $22 | — | $22 | 0.31% |
| RONALD H RICHEY3 | 4023 LAURAWOOD LN FRANKLIN, TN 37067 | AFLAC | $14 | — | $14 | 0.20% |
| BRENDA S SPEER3 | PO BOX 327 PULASKI, TN 38478 | AFLAC | $12 | — | $12 | 0.17% |
| BEVERLY GATES3 Filed as: BEVERLY G GATES | 149 DORRIS RD PORTLAND, TN 37148 | AFLAC | $10 | — | $10 | 0.14% |
| PAMELA W EZZELL3 | 2947 CHERRYBARK CT HERMITAGE, TN 37076 | AFLAC | $7 | — | $7 | 0.10% |
| AMY B CITRON3 | 1024 GRANADA AVE NASHVILLE, TN 37206 | AFLAC | $7 | — | $7 | 0.10% |
| JERRY LEE BROCKMAN3 | 5804 LEATHERBROOK DR COLUMBIA, MO 65203 | AFLAC | $6 | — | $6 | 0.08% |
| JAN HAMBY ALDAMUY3 | 16203 MUIRFIELD DR ODESSA, FL 33556 | AFLAC | $5 | — | $5 | 0.07% |
| RICHARD D HEYDEL3 | 1921 OLD HICKORY BLVD BRENTWOOD, TN 37027 | AFLAC | $5 | — | $5 | 0.07% |
| LESLIE H SILTMAN3 | 207 MOORE DR BATESVILLE, MS 38606 | AFLAC | $5 | — | $5 | 0.07% |
| JULIE L TEMPLETON3 | 709 HELMSDALE PL S BRENTWOOD, TN 37027 | AFLAC | $4 | — | $4 | 0.06% |
| SHAUNA A BERRY3 | 12555 BIGELOW RD DUNDEE, MI 48131 | AFLAC | $3 | — | $3 | 0.04% |
| KIMBERLY MURRAY3 | 8530 WOODLANE DR GERMANTOWN, TN 38138 | AFLAC | $1 | — | $1 | 0.01% |
| AUTUMN BETHEA3 | 1053 MUNA CT SPRING HILL, TN 37174 | AFLAC | $1 | — | $1 | 0.01% |
| KANDI H HECKLER3 | 5453 HASELL DR ROCKVALE, TN 37153 | AFLAC | $1 | — | $1 | 0.01% |
| JAN HAMBY ALDAMUY3 | 231 MONTEGO CT OLDSMAR, FL 34677 | AFLAC | $1 | — | $1 | 0.01% |
| DAVID FORD3 Filed as: DAVID M FORD | PO BOX 161 WHITE BLUFF, TN 37187 | COMPANION LIFE | $564 | — | $564 | 9.66% |
| GROUP INSURANCE SERVICES INC3 Filed as: GROUP INSURANCE SERVICES | 1 CAMERON HILL CIRCLE - 2.5 CHATTANOOGA, TN 37402 | COMPANION LIFE | $282 | — | $282 | 4.83% |
| DAVID FORD3 Filed as: DAVID MONROE FORD, PETER CALABRESE | PO BOX 161 WHITE BLUFF, TN 37187 | ASSURITY LIFE INSURANCE COMPANY | $115 | — | $115 | 3.75% |
| DAVID FORD3 Filed as: DAVID M FORD | PO BOX 161 WHITE BLUFF, TN 37187 | COMPANION LIFE | $293 | — | $293 | 9.66% |
| GROUP INSURANCE SERVICES INC3 Filed as: GROUP INSURANCE SERVICES | 1 CAMERON HILL CIRCLE - 2.5 CHATTANOOGA, TN 37402 | COMPANION LIFE | $146 | — | $146 | 4.81% |
| DAVID FORD3 Filed as: DAVID MONROE FORD | PO BOX 161 WHITE BLUFF, TN 37187 | AFLAC | $67 | — | $67 | 6.62% |
| KANDI M MCINTYRE3 | 2000 MALLORY LN STE 130-378 FRANKLIN, TN 37067 | AFLAC | $16 | — | $16 | 1.58% |
| AMY B CITRON3 | 1024 GRANADA AVE NASHVILLE, TN 37206 | AFLAC | $14 | — | $14 | 1.38% |
| ROBERT L GOBLE3 | 1410 4TH STREET DR NW UNIT 208 HICKORY, NC 28601 | AFLAC | $7 | — | $7 | 0.69% |
| PAMELA W EZZELL3 | 2947 CHERRYBARK CT HERMITAGE, TN 37076 | AFLAC | $2 | — | $2 | 0.20% |
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 | 210 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 210 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF TENNESSEE, INC | 210 | $727K |
| Dental(4 contracts) | COMPANION LIFE | 73 | $53K |
| Life insurance(4 contracts, 3 carriers) | USABLE LIFE | 188 | $49K |
| Short-term disability(3 contracts, 2 carriers) | ASSURITY LIFE INSURANCE COMPANY | 139 | $41K |
| Long-term disability | USABLE LIFE | 188 | $55K |
| Other(5 contracts, 3 carriers) | ASSURITY LIFE INSURANCE COMPANY | 188 | $85K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 210 | — |
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.