| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RUSS BLAKELY & ASSOCIATES LLC3 Filed as: RUSS BLAKELY | PO BOX 11310 CHATTANOOGA, TN 37401 | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | $43K | — | $43K | 4.64% |
| WILLIAM R BLAKELY3 | PO BOX 11310 CHATTANOOGA, TN 37401 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | $682 | $10K | 8.09% |
| BLAKELY, WILLIAM R3 Filed as: BLAKELY, WILLIAM, RUSSELL | PO BOX 11310 CHATTANOOGA, TN 37401 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $116 | $2K | 10.77% |
| STALVEY, MICHAEL, DEWAYNE3 | 9622 WILTSHIRE DRIVE OOLTEWAH, TN 37363 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 9.09% |
| BOAR ENROLLMENT STRATEGIES3 | 9622 WILTSHIRE DRIVE OOLTEWAH, TN 37363 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $165 | — | $165 | 0.99% |
| BLAKELY, WILLIAM R3 Filed as: BLAKELY WILLIAM R | PO BOX 11310 CHATTANOOGA, TN 37401 | UNIUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $117 | $2K | 15.86% |
| WILLAIM R BLAKELY RUSS BAKELY &3 | PO BOX 11310 CHATTANOOGA, TN 37401 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $532 | $175 | $707 | 13.28% |
| THE MATHIS-HILL-ROBERTSON AGENCY3 Filed as: THE MATHIS-HILL-ROBERTSON AGEN | 5040 ROSWELL ROAD SUITE 100 ATLANTA, GA 30342 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $40 | — | $40 | 0.75% |
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 | 123 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 123 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | 220 | $936K |
| Dental | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | 220 | $936K |
| Vision(2 contracts, 2 carriers) | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | 220 | $941K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 71 | $121K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 71 | $121K |
| Other(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 71 | $152K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 220 | — |
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.