| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ORMA R SMITH III3 Filed as: ORMA RINEHART SMITH | — | BLUECROSS BLUESHIELD OF ILLINOIS | $50K | — | $50K | 3.03% |
| FIRST STATE INSURANCE LLC3 | — | BLUECROSS BLUESHIELD OF ILLINOIS | $13K | — | $13K | 0.79% |
| ORMA R SMITH III3 Filed as: ORMA SMITH | 3725 CHAMPION HILLS DRIVE SUITE 3300 MEMPHIS, TN 38125 | METROPOLITAN LIFE INSURANCE COMPANY | $8K | — | $8K | 7.60% |
| SIMMONS FIRST INSURANCE SERVICES3 Filed as: SIMMONS FIRST INSURANCE SERVICES OF | 480 OIL WELL ROAD JACKSON, TN 38305 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | $842 | $3K | 2.44% |
| ORMA R SMITH III3 | 3725 CHAMPION HILLS DRIVE SUITE 3300 MEMPHIS, TN 38125 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | $11K | — | $11K | 13.62% |
| SIMMONS FIRST INSURANCE SERVICES3 Filed as: SIMMONS FIRST INS SRVS OF TN LLL | 480 OIL WELL ROAD JACKSON, TN 38305 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | $2K | — | $2K | 2.93% |
| SMITH III, ORMA R3 Filed as: SMITH III, ORMA, R | 3725 CHAMPION HILLS DRIVE SUITE 3300 MEMPHIS, TN 38125 | AMERITAS LIFE INSURANCE CORP. | $2K | — | $2K | 8.38% |
| SIMMONS FIRST INSURANCE SERVICES3 Filed as: SIMMONS FIRST INSURANCE SRVCS OF TN | 480 OIL WELL ROAD JACKSON, TN 38305 | AMERITAS LIFE INSURANCE CORP. | $470 | — | $470 | 1.62% |
| SMITH III, ORMA R3 Filed as: SMITH, ORMA, R | 3725 CHAMPION HILLS DRIVE SUITE 330 MEMPHIS, TN 38125 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $213 | — | $213 | 2.41% |
| SMITH III, ORMA R3 Filed as: SMITH, ORMA, R | 3725 CHAMPION HILLS DRIVE SUITE 330 MEMPHIS, TN 38125 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 2.03% |
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 | 172 | 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) | 172 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF ILLINOIS | 239 | $1.7M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 415 | $111K |
| Vision | AMERITAS LIFE INSURANCE CORP. | 264 | $29K |
| Life insurance | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 172 | $78K |
| Short-term disability | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 172 | $78K |
| Long-term disability | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 172 | $78K |
| Other(3 contracts, 3 carriers) | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 172 | $87K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 415 | — |
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."
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.