| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIGITAL INSURANCE LLC3 | 200 GALLERIA PKWY STE 1950 ATLANTA, GA 30339 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $4K | $1K | $6K | 13.03% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $18 | $18 | 0.04% |
| MATTHEW B MORASKI3 | 1600 DIVISION STREET STE 420 NASHVILLE, TN 37207 | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | $3K | — | $3K | 10.98% |
| DIGITAL INSURANCE LLC3 | 200 GALLERIA PARKWAY ATLANTA, GA 30339 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $90 | $2K | 5.18% |
| DANIEL JAMES PERKINS3 | 9655 BRUNSWICK DR BRENTWOOD, TN 37027 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $851 | — | $851 | 2.87% |
| NICHOLAS MOOR WEISSFELD3 | 1309 KNIGHTSBRIDGE DR KNOXVILLE, TN 37922 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $672 | $84 | $756 | 2.55% |
| WILLIAM RICHARD KYZER3 | 8211 GORDON LN HERMITAGE, TN 37076 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $118 | $53 | $171 | 0.58% |
| BENEFOUNDRY INC3 | 3013 LARGE HOP LN ANTIOCH, TN 37013 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $65 | $52 | $117 | 0.39% |
| CARLA STINER REEL3 | 12322 MALLARD BAY DR KNOXVILLE, TN 37922 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $45 | — | $45 | 0.15% |
| LAURIE J BURNS3 Filed as: LAURIE JANE BURNS | 1274 BICYCLE CT YORK, SC 29745 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $22 | — | $22 | 0.07% |
| PALMETTO BENEFIT SOLUTIONS LLC3 | 5264B INTNL BLVD STE 200 NORTH CHARLESTON, SC 29418 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | $7 | $10 | 0.03% |
| ADVANCED BENEFIT SYSTEM INC3 | 145 RIVER LANDING DR UNIT 203 DANIEL ISLAND, SC 29492 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | $1 | $2 | 0.01% |
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 | 96 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 97 | 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 | 50 | $198K |
| Dental | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | 75 | $31K |
| Vision | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | 75 | $31K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 94 | $44K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 94 | $44K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 94 | $44K |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 94 | $73K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 94 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.