Form 5500 · Employee benefit plan · KNOXVILLE, TN
SOUTHEASTERN RETINA ASSOCIATES, P.C.
The filing calls this plan SOUTHEASTERN RETINA ASSOCIATES, PC, EMPLOYEE BENEFITS PLAN.
SOUTHEASTERN RETINA ASSOCIATES, P.C. of KNOXVILLE, TN is a 343-participant health care and social assistance employer whose group benefits are disclosed in its annual Form 5500 filing. Its broker of record is RYAN GROSE. Coverage is written through BLUE CROSS AND BLUE SHIELD OF EAST 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 62-1094813 · plan 503 · plan year 2025, filed Jul 29, 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.
Benefits declared on this filing
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 3 insured contracts covering health, dental, vision, life and disability; the largest, with BLUE CROSS AND BLUE SHIELD OF EAST TENNESSEE, INC, covers 355 people.
Reported premium is $2,492,218; the filing discloses no broker commission on these contracts.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
RYAN GROSE is the broker of record on 1 of the 3 contracts; the rest name a different broker or none.
3 carriers appear on the filing, including BLUE CROSS AND BLUE SHIELD OF EAST TENNESSEE, INC, DELTA DENTAL OF TENNESSEE and HARTFORD LIFE AND ACCIDENT. BLUE CROSS AND BLUE SHIELD OF EAST TENNESSEE, INC writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| BLUE CROSS AND BLUE SHIELD OF EAST TENNESSEE, INC | Health, Vision | 355 | Jan 1, 2026 | $2,349,785 | $0 |
| DELTA DENTAL OF TENNESSEE | Dental | 376 | Jan 1, 2026 | $113,926 | $0 |
| HARTFORD LIFE AND ACCIDENT | Health, Life, Disability | 336 | Jan 1, 2026 | $28,507 | $0 |
Premium and claims on these contracts
BLUE CROSS AND BLUE SHIELD OF EAST TENNESSEE, INC, contract 134102. For the contract year on this filing, the carrier reported $2,349,785 in premium earned and $2,065,646 in claims incurred. Dividing one by the other gives 88%.
DELTA DENTAL OF TENNESSEE, contract 7895. For the contract year on this filing, the carrier reported $113,926 in premium earned and $78,980 in claims incurred. Dividing one by the other gives 69%.
- BLUE CROSS AND BLUE SHIELD OF EAST TENNESSEE, INC, contract 134102 reported $328,601 in retention.
- DELTA DENTAL OF TENNESSEE, contract 7895 reported $22,216 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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