Form 5500 · Employee benefit plan · GOODLETSVILLE, TN
BOARD OF TRUSTEES-SHEET METAL LOCAL 110 HEALTH FUND
The filing calls this plan SHEET METAL WORKERS LOCAL NO. 110 HEALTH FUND.
BOARD OF TRUSTEES-SHEET METAL LOCAL 110 HEALTH FUND of GOODLETSVILLE, TN spreads its employee benefits across 4 insurance carriers, according to its Form 5500 Schedule A. Its broker of record is R H CLARKSON FINANCIAL. Coverage is written through ANTHEM BLUE CROSS BLUE SHIELD and 3 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 55-0711972 · plan 501 · plan year 2024, filed Oct 15, 2025
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1,160 other employer plans in Tennessee have policy years ending in December. See the full list on the renewal calendar, or ask for it in Claude or ChatGPT.
How this plan is funded
Fully insured as reported
The plan's own financial statement reports paying insurance carriers about what the insurance contracts report in premium.
Benefits declared on this filing
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 4 insured contracts covering health, dental, life and disability; the largest, with ANTHEM BLUE CROSS BLUE SHIELD, covers 894 people.
The filing declares health, dental, life, disability and vision. Vision 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 $14,035,340, with $310,293 in disclosed broker commissions — about 2.2% of premium.
The health contract's policy period ended in December, while at least one ancillary line's policy period ended in June. The plan is on a split renewal cycle.
R H CLARKSON FINANCIAL is the broker of record on 1 of the 4 contracts; the rest name a different broker or none.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| ANTHEM BLUE CROSS BLUE SHIELD | Health | 894 | Jan 1, 2025 | $12,348,155 | $303,820 |
| PRUDENTIAL INSURANCE COMPANY OF AMERICA | Life, Disability | 1,107 | Jul 1, 2024 | $129,458 | $6,473 |
| HUMANA INSURANCE COMPANY | Health | 279 | Jan 1, 2025 | $1,002,465 | $0 |
| DELTA DENTAL | Dental | 2,376 | Jan 1, 2025 | $555,262 | $0 |
Premium and claims on this contract
DELTA DENTAL, contract 0711330. For the contract year on this filing, the carrier reported $555,262 in premium earned and $512,268 in claims incurred. Dividing one by the other gives 92%.
- DELTA DENTAL, contract 0711330 reported $43,912 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. The service providers are named on Schedule C of this filing. We publish company names only.
Money the plan held and paid out
Sourced from U.S. DOL EFAST2 Form 5500 · Schedule H
These are the plan's own figures from Schedule H, the financial statement it files. They are not the premium on Schedule A.
How this plan compares
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Renewal calendar
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