| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: TIS INSURANCE SERVICES INC | 1900 WINSTON ROAD SUITE 100 KNOXVILLE, TN 37919 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $11K | $4K | $16K | 13.73% |
| PEACHTREE PLANNING OF GEORGIA3 | — | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $856 | — | $856 | 0.75% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: TIS INSURANCE SERVICES INC | 1900 NORTH WINSTON ROAD KNOXVILLE, TN 37919 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $11K | $1K | $13K | 22.39% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 2.05% |
| JENNINGS INSURANCE SERVICES3 | 10524 MOSS PARK ROAD #206-306 ORLANDO, FL 32832 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 1.86% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: TIS INSURANCE SERVICES INC | 1900 NORTH WINSTON ROAD KNOXVILLE, TN 37919 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $12K | $2K | $13K | 24.82% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 2.42% |
| JENNINGS INSURANCE SERVICES3 | 10524 MOSS PARK ROAD #206-306 ORLANDO, FL 32832 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 1.99% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: TIS INSURANCE SERVICES INC | 1900 NORTH WINSTON ROAD KNOXVILLE, TN 37919 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $913 | $3K | 7.37% |
| JENNINGS INSURANCE SERVICES3 | 10524 MOSS PARK ROAD #206-306 ORLANDO, FL 32832 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 2.75% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $782 | $782 | 2.03% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: TIS INSURANCE SERVICES INC | PO BOX 10328 KNOXVILLE, TN 37939 | SUN LIFE ASSURANCE COMPANY OF CANADA | $7K | — | $7K | 18.81% |
| JENNINGS INSURANCE SERVICES3 | 10524 MOSS PARK ROAD #206-306 ORLANDO, FL 32832 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 12.67% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: TIS INSURANCE SERVICES INC | 1900 NORTH WINSTON ROAD KNOXVILLE, TN 37919 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $419 | $195 | $614 | 7.33% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $167 | $167 | 1.99% |
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 | 104 | 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) | 104 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF ALABAMA | 132 | $1.4M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 156 | $114K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 156 | $114K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 173 | $62K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 81 | $57K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 53 | $39K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF ALABAMA | 132 | $1.4M |
| Other(4 contracts, 3 carriers) | BLUE CROSS AND BLUE SHIELD OF ALABAMA | 173 | $1.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 173 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.