Form 5500 · Employee benefit plan · MADISON, TN
NASHVILLE DENTAL, INC.
The filing calls this plan NASHVILLE DENTAL, INC. EMPLOYEE BENEFITS PLAN.
NASHVILLE DENTAL, INC. of MADISON, TN files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Its broker of record is BROWN & BROWN OF TENNESSEE INC. Coverage is written through CIGNA HEALTH AND LIFE INSURANCE COMPANY and 2 other carriers. The plan's most recent policy period ended in May.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 62-0304640 · plan 501 · plan year 2025, filed Dec 19, 2025
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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
5 contracts on this filing do not say which benefits they cover, so a line above may be insured by one of them.
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 11 insured contracts covering dental, vision, life and disability; the largest, with CIGNA HEALTH AND LIFE INSURANCE COMPANY, covers 110 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, placed with a carrier that is not on this filing, or written on one of the 5 contracts here that do not say what they cover.
Reported premium across the insured contracts is $243,085, with $25,852 in disclosed broker commissions — about 11% of premium.
The most recent policy period ended in May, and the plan year ends May 31. Group contracts typically renew on that annual cycle.
BROWN & BROWN OF TENNESSEE INC is the broker of record on 9 of the 11 contracts; the rest name a different broker or none.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life | 71 | Jun 1, 2025 | $48,194 | $7,229 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Disability | 115 | Jun 1, 2025 | $32,790 | $4,918 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | — | 44 | Jun 1, 2025 | $22,100 | $3,315 |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY | Dental, Vision | 110 | Jun 1, 2025 | $89,746 | $2,737 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Disability | 115 | Jun 1, 2025 | $15,594 | $2,339 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | — | 54 | Jun 1, 2025 | $12,358 | $1,854 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | — | 27 | Jun 1, 2025 | $8,575 | $1,715 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life | 115 | Jun 1, 2025 | $4,620 | $713 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY | Life | 8 | Jun 1, 2025 | $6,656 | $667 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY | — | 3 | Jun 1, 2025 | $1,342 | $295 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY | — | 4 | Jun 1, 2025 | $1,110 | $70 |
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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