Form 5500 · Employee benefit plan · NASHVILLE, TN
4PATRIOTS, LLC
The filing calls this plan 4PATRIOTS, LLC HEALTH AND WELFARE PLAN.
Public Form 5500 records show how 4PATRIOTS, LLC of NASHVILLE, TN, a wholesale trade employer, structures its employee benefits. Its broker of record is CBIZ BENEFITS & INSURANCE SERVICES. Coverage is written through DELTA DENTAL OF TENNESSEE and 1 other carrier. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 26-3660567 · plan 501 · plan year 2025, filed Jul 28, 2026
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How this plan is funded
Funding not settled by the filing
The filing does not report enough to settle how this plan pays for benefits.
Benefits declared on this filing
Also declared: other welfare.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 6 insured contracts covering dental, vision, life and disability; the largest, with DELTA DENTAL OF TENNESSEE, covers 196 people.
The filing declares dental, vision, life, disability and health. Health appears with no insured contract on Schedule A. That coverage may be self-funded, or placed with a carrier that is not on this filing.
Reported premium across the insured contracts is $194,750, with $22,624 in disclosed broker commissions — about 12% of premium.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
CBIZ BENEFITS & INSURANCE SERVICES is the broker of record on all 6 contracts.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| DELTA DENTAL OF TENNESSEE | Dental | 196 | Jan 1, 2026 | $95,144 | $8,911 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life | 49 | Jan 1, 2026 | $28,143 | $4,222 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Disability | 44 | Jan 1, 2026 | $25,633 | $3,845 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Disability | 132 | Jan 1, 2026 | $20,059 | $3,009 |
| DELTA DENTAL OF TENNESSEE | Vision | 149 | Jan 1, 2026 | $21,926 | $2,060 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life | 132 | Jan 1, 2026 | $3,845 | $577 |
Premium and claims on these contracts
DELTA DENTAL OF TENNESSEE, contract 8417. For the contract year on this filing, the carrier reported $86,692 in premium earned and $68,415 in claims incurred. Dividing one by the other gives 79%.
DELTA DENTAL OF TENNESSEE, contract V8417. For the contract year on this filing, the carrier reported $19,843 in premium earned and $12,489 in claims incurred. Dividing one by the other gives 63%.
- DELTA DENTAL OF TENNESSEE, contract 8417 reported $20,156 in retention.
- DELTA DENTAL OF TENNESSEE, contract V8417 reported $6,994 in retention.
Retention is what the carrier kept of the premium after claims, as reported: administration, commissions and other charges.
Only experience-rated contracts report these figures, so most filings leave them blank.
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Other plans filed by this employer
How this plan compares
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