Form 5500 · Employee benefit plan · NEW TAZEWELL, TN
HOMESTEADER, LLC
The filing calls this plan HOMESTEADER LLC WELFARE BENEFITS PLAN.
HOMESTEADER, LLC of NEW TAZEWELL, TN files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Its broker of record is RICK METZELDER. Coverage is written through BLUECROSS BLUESHIELD OF TENNESSEE, INC.. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 83-2639525 · plan 501 · plan year 2025, filed Jul 28, 2026
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How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
The filing carries code 4S: this plan is filing again after previously being exempt.
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.
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 1 insured contract covering health, dental and vision; the largest, with BLUECROSS BLUESHIELD OF TENNESSEE, INC., covers 171 people.
Reported premium across the insured contracts is $530,640, with $44,483 in disclosed broker commissions — about 8.4% 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.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. | Health, Dental, Vision | 171 | Jan 1, 2026 | $530,640 | $44,483 |
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.
Reported to OSHA
Reported to OSHA for 2025: 19 employees, 0 recordable cases, 0 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Other plans filed by this employer
How this plan compares
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