Form 5500 · Employee benefit plan · KINGSTON, TN
MICHAEL DUNN CENTER
The filing calls this plan MEDICAL, DENTAL, VISION.
MICHAEL DUNN CENTER of KINGSTON, TN insures health, dental and vision coverage for its employees, per Schedule A of its Form 5500. Its broker of record is ROBERT PEACE. 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 62-0851179 · plan 501 · plan year 2023, filed Oct 7, 2024
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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
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 169 people.
Reported premium across the insured contracts is $102,455, with $11,037 in disclosed broker commissions — about 11% 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 | 169 | Jan 1, 2024 | $102,455 | $11,037 |
Premium and claims on this contract
BLUECROSS BLUESHIELD OF TENNESSEE, INC., contract 30455. For the contract year on this filing, the carrier reported $102,455 in premium earned and $110,841 in claims incurred. Dividing one by the other gives 108%.
- BLUECROSS BLUESHIELD OF TENNESSEE, INC., contract 30455 reported $14,350 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.
Other plans filed by this employer
How this plan compares
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