| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DAVID M CRUMLEY3 Filed as: DAVID MATT COWAN | COWAN BENEFIT SERVICSE, INC. 5110 MARYLAND WAY STE 250 BRENTWOOD, TN 37027 | BLUECROSS BLUESHIELD OF TENNSSEE, INC. | — | $5K | $5K | 7.19% |
| ENROLLEASE3 Filed as: COWAN BENEFIT SERVICES, INC. | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $0 | $1K | 7.59% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | $369 | $0 | $369 | 2.42% |
| ENROLLEASE3 Filed as: COWAN BENEFIT SERVICES, INC. | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | $733 | — | $733 | 5.30% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | $234 | — | $234 | 1.69% |
| ENROLLEASE3 Filed as: COWAN BENEFIT SERVICES INC. | — | VISION SERVICE PLAN | $571 | $0 | $571 | 5.91% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | — | VISION SERVICE PLAN | $395 | $0 | $395 | 4.09% |
| ENROLLEASE3 Filed as: COWAN BENEFIT SERVICES, INC. | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | $691 | — | $691 | 9.74% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | $231 | — | $231 | 3.26% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COWAN BENEFITS SERVICES INC NONE | Insurance agents and brokers Service code 22 | 1510 MARYLAND WAY STE 250 BRENTWOOD, TN 37027 | $18K |
| HUB INTERNATIONAL GULF SOUTH LTD NONE | Insurance agents and brokers Service code 22 | PO BOX 6650 METAIRIE, LA 70009 | $9K |
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 | 161 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 164 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE CO. | 161 | $552K |
| Dental | BLUECROSS BLUESHIELD OF TENNSSEE, INC. | 197 | $70K |
| Vision | VISION SERVICE PLAN | 73 | $10K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 123 | $15K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 123 | $15K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 123 | $21K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 197 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.