| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JACK B TURNER3 Filed as: JACK B. TURNER | 201 MAIN STREET CLARKSVILLE, TN 37041 | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | $43K | — | $43K | 7.15% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SERVICES, | INC P.O. BOX 632886 CINCINNATI, OH 452632886 | PRINCIPAL LIFE INSURANCE COMPANY | $3K | $20 | $3K | 13.93% |
| JACK B TURNER3 Filed as: JACK B. TURNER | 310 FAIRWAY DRIVE CLARKSVILLE, TN 37040 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 7.38% |
| BENEFITS INC3 Filed as: BENEFITS, INC. | PO BOX 568 DICKSON, TN 37056 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $616 | — | $616 | 3.88% |
| THE MATHIS-HILL-ROBERTSON AGENCY3 | 5040 ROSWELL ROAD, STE. 100 ATLANTA, GA 30342 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $35 | — | $35 | 0.22% |
| JACK B TURNER3 Filed as: JACK B. TURNER | 201 MAIN STREET CLARKSVILLE, TN 37041 | USABLE LIFE | $938 | — | $938 | 15.00% |
| GROUP INSURANCE SERVICES INC3 Filed as: GROUP INSURANCE SERVICES, INC. | 1 CAMERON HILL CIRCLE 2.5 CHATTANOOGA, TN 37402 | USABLE LIFE | $638 | $125 | $763 | 12.20% |
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 | 119 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 126 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | 154 | $601K |
| Dental | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | 154 | $601K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 79 | $16K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 79 | $16K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 117 | $22K |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 79 | $22K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 154 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.