| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIAM D STAEDKE3 | PO BOX 140803 BROKEN ARROW, OK 74014 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $4K | $6K | 13.80% |
| INTERNATIONL INSURANCE BROKERS LTD3 | PO BOX 35487 TULSA, OK 74153 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $0 | $3K | 5.81% |
| SHANNON MARIE BALDWIN3 | 10222 E 114TH ST S BIXBY, OK 74008 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $412 | $338 | $750 | 1.68% |
| KELLY W PUGH3 | 7357 S 286TH EAST AVE BROKEN ARROW, OK 74014 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $431 | $305 | $736 | 1.65% |
| BENEFIT ENROLLMENT SERVICES INC3 | 4701 TROUSDALE DRIVE NASHVILLE, TN 37220 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $100 | $623 | $723 | 1.62% |
| MARILYNN DECKER3 | 5173 JOHN HAGAR RD HERMITAGE, TN 37076 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $464 | $196 | $660 | 1.48% |
| MARILYN K EMBERSON3 | 7220 N HAMMOND AVENUE OKLAHOMA CITY, OK 73132 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $217 | $109 | $326 | 0.73% |
| BRANDI TAFT3 | 822 B NEARTOP DRIVE NASHVILLE, TN 37205 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $152 | $163 | $315 | 0.71% |
| BRENDA H BRIDGES3 | 223 SHADY LANE WHITE HOUSE, TN 37188 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $175 | $69 | $244 | 0.55% |
| MARY DAUGHERTY3 | 7625 STAR GAZING LANE KNOXVILLE, TN 37938 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $58 | $41 | $99 | 0.22% |
| LALETTA SMITH3 | 118 ROSE GARDEN LANE GOODLETTSVILLE, TN 37076 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $68 | $5 | $73 | 0.16% |
| JAMES A SHARP3 | 1021 TULIP BLOSSOM DRIVE HERMITAGE, TN 37076 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $52 | $0 | $52 | 0.12% |
| JOSEPH M TAMER3 | 6500 PAPERMILL DR KNOXVILLE, TN 37919 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $9 | $43 | $52 | 0.12% |
| JULIA MICHELLE TAMER3 | 6500 PAPERMILL RD SUITE 106 KNOXVILLE, TN 37919 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $7 | $19 | $26 | 0.06% |
| JERRY W HOOPER3 Filed as: JERRY HOOPER | 6044 MAYSBROOK LANE FRANLIN, TN 37064 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $14 | $0 | $14 | 0.03% |
| DENNIS E TRAYWICK3 | 4701 TROUSDALE DR NASHVILLE, TN 37220 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $11 | $0 | $11 | 0.02% |
| PAULA HARGIS3 | 101 WESLEY ROAD LENOIR, TN 37772 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $9 | $0 | $9 | 0.02% |
| WILLIAM RICHARD KYZER3 | PO BOX 8213 HERMITAGE, TN 37076 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $7 | $0 | $7 | 0.02% |
| JESSICA LEAH SCHNEIDER3 | 210 CARDEN AVE NASHVILLE, TN 37205 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $5 | $0 | $5 | 0.01% |
| JUDY L CHANDLER3 | 8831 HEISKELL ROAD POWELL, TN 37849 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1 | $0 | $1 | 0.00% |
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 | 103 | 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. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 103 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 188 | $45K |
| Other | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 188 | $45K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 188 | — |
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.