Form 5500 · Employee benefit plan · KNOXVILLE, TN
PREMIER SURGICAL ASSOCIATES PLLC
The filing calls this plan PREMIER SURGICAL ASSOCIATES PLLC EMPLOYEE BENEFITS PLAN.
PREMIER SURGICAL ASSOCIATES PLLC of KNOXVILLE, TN spreads its employee benefits across 3 insurance carriers, according to its Form 5500 Schedule A. Its broker of record is HUB INTERNATIONAL MIDWEST LIM. Coverage is written through BLUECROSS BLUESHIELD OF TENNESSEE, INC. and 2 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 62-1611998 · plan 576 · plan year 2025, filed Jul 15, 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
Health: UNUM INSURANCE COMPANY covers 19 of 204 participants (9.3%) on Schedule A.
Also declared: death benefits, 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 7 insured contracts covering health, dental, vision, life and disability; the largest, with BLUECROSS BLUESHIELD OF TENNESSEE, INC., covers 308 people.
Reported premium across the insured contracts is $323,372, with $30,162 in disclosed broker commissions — about 9.3% 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.
HUB INTERNATIONAL MIDWEST LIM is the broker of record on 6 of the 7 contracts; the rest name a different broker or none.
3 carriers appear on the filing, including BLUECROSS BLUESHIELD OF TENNESSEE, INC., UNUM LIFE INSURANCE COMPANY OF AMERICA and UNUM INSURANCE COMPANY. BLUECROSS BLUESHIELD OF TENNESSEE, INC. writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| UNUM LIFE INSURANCE COMPANY OF AMERICA | Life | 100 | Jan 1, 2026 | $73,930 | $10,446 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA | Life, Disability | 218 | Jan 1, 2026 | $85,242 | $5,863 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA | Disability | 36 | Jan 1, 2026 | $40,931 | $5,859 |
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. | Dental, Vision | 308 | Jan 1, 2026 | $104,269 | $5,335 |
| UNUM INSURANCE COMPANY | Health | 19 | Jan 1, 2026 | $6,337 | $1,048 |
| UNUM INSURANCE COMPANY | — | 30 | Jan 1, 2026 | $6,735 | $813 |
| UNUM INSURANCE COMPANY | — | 14 | Jan 1, 2026 | $5,928 | $798 |
Premium and claims on this contract
BLUECROSS BLUESHIELD OF TENNESSEE, INC., contract 142077. For the contract year on this filing, the carrier reported $104,269 in premium earned and $79,217 in claims incurred. Dividing one by the other gives 76%.
- BLUECROSS BLUESHIELD OF TENNESSEE, INC., contract 142077 reported $22,961 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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