| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JOHN S HAWKINS3 | 13800 JACKSON RD MISHAWAKA MISHAWAKA, IN 46544 | BLUECROSS BLUESHIELD OF TN, INC. | — | $10K | $10K | 1.58% |
| OCHS INC3 | 400 ROBERT ST N, SUITE 1880 ST. PAUL, MN 55101 | MINNESOTA LIFE INSURANCE COMPANY | — | $17K | $17K | 12.60% |
| OCHS INC3 | 400 ROBERT ST NO ST. PAUL, MN 55101 | MINNESOTA LIFE INSURANCE COMPANY | — | $1K | $1K | 12.60% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUECROSS BLUESHIELD OF TN, INC. EIN 62-0427913 NONE | Contract Administrator Service code 13 | 1 CAMERON HILL CIRCLE CHATTANOOGA, TN 37402 | $387K |
| CROSSLIN, PLLC EIN 27-5360847 NONE | Accounting (including auditing) Service code 10 | 3803 BEDFORD AVENUE, SUITE 103 NASHVILLE, TN 37215 | $12K |
| THORNTHWAITE & CO EIN 62-1257065 NONE | Actuarial Service code 11 | 5141 VIRGINIA WAY, SUITE 330 BRENTWOOD, TN 37027 | $7K |
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 | 616 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 173 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 789 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF TN, INC. | 1,954 | $623K |
| Dental | BLUECROSS BLUESHIELD OF TN, INC. | 1,954 | $623K |
| Life insurance(2 contracts) | MINNESOTA LIFE INSURANCE COMPANY | 1,352 | $144K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,954 | — |
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.