Form 5500 · Employee benefit plan · DECATUR, TN
STORM POWER COMPONENTS
The filing calls this plan STORM COPPER COMPONENTS CO. LIFE INSURANCE PLAN.
Public Form 5500 records show how STORM POWER COMPONENTS of DECATUR, TN, a manufacturing employer, structures its employee benefits. Its broker of record is ANDREW MANN. Coverage is written through BLUECROSS BLUESHIELD OF TENNESSEE, INC. and 3 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 62-1485943 · plan 502 · plan year 2025, filed Jul 21, 2026
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1,160 other employer plans in Tennessee have policy years ending in December. See the full list on the renewal calendar, or ask for it in Claude or ChatGPT.
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.
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 4 insured contracts covering health, dental, vision, life and disability; the largest, with BLUECROSS BLUESHIELD OF TENNESSEE, INC., covers 289 people.
Reported premium across the insured contracts is $1,813,521, with $119,942 in disclosed broker commissions — about 6.6% 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.
ANDREW MANN is the broker of record on 1 of the 4 contracts; the rest name a different broker or none.
4 carriers appear on the filing, including BLUECROSS BLUESHIELD OF TENNESSEE, INC., UNITED OF OMAHA LIFE INSURANCE COMPANY, DELTA DENTAL OF TENNESSEE and METROPOLITAN LIFE INSURANCE COMPANY. BLUECROSS BLUESHIELD OF TENNESSEE, INC. writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. | Health | 289 | Jan 1, 2026 | $1,528,000 | $82,681 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life, Disability | 239 | Jan 1, 2026 | $169,346 | $25,401 |
| DELTA DENTAL OF TENNESSEE | Dental | 298 | Jan 1, 2026 | $101,271 | $10,186 |
| METROPOLITAN LIFE INSURANCE COMPANY | Vision | 245 | Jan 1, 2026 | $14,904 | $1,674 |
Premium and claims on these contracts
BLUECROSS BLUESHIELD OF TENNESSEE, INC., contract 122962. For the contract year on this filing, the carrier reported $1,528,000 in premium earned and $1,555,699 in claims incurred. Dividing one by the other gives 102%.
DELTA DENTAL OF TENNESSEE, contract 5676. For the contract year on this filing, the carrier reported $101,107 in premium earned and $49,104 in claims incurred. Dividing one by the other gives 49%.
- BLUECROSS BLUESHIELD OF TENNESSEE, INC., contract 122962 reported $274,958 in retention.
- DELTA DENTAL OF TENNESSEE, contract 5676 reported $23,760 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.
Reported to OSHA
Reported to OSHA for 2025: 320 employees, 10 recordable cases, 88 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
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