| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS INC | 1105 NIKKI VIEW DR BRANDON, FL 33511 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $47K | $3K | $50K | 11.04% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS INC | 1105 NIKKI DR BRANDON, FL 33511 | UNION SECURITY INSURANCE COMPANY | $21K | — | $21K | 10.00% |
| SULLIVAN GROUP LLC3 Filed as: SULLIVAN BENEFITS | 1105 NIKKI VIEW DR BRANDON, FL 33511 | ADVANTICA REINSURANCE COMPANY | $3K | — | $3K | 10.00% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS INC | 1105 NIKKI VIEW DR BRANDON, FL 33511 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $9 | $1K | 6.76% |
| SMITH, THOMAS, CHRISTOPHER3 | 2928 FOSTER CREIGHTON DR NASHVILLE, TN 37204 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $713 | $66 | $779 | 4.43% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS INC | 1105 NIKKI VIEW DR BRANDON, FL 33511 | PROVIDENT LFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 8.90% |
| SMITH, THOMAS, CHRISTOPHER3 | 2928 FOSTER CREIGHTON DR NASHVILLE, TN 37204 | PROVIDENT LFE AND ACCIDENT INSURANCE COMPANY | $741 | $45 | $786 | 6.06% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR INC EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $350K |
| REFINED BENEFITS INC EIN 59-3652048 BROKER | Other commissions Service code 55 | 1105 NIKKI VIEW DR BRANDON, FL 33511 | $51K |
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 694 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 694 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | UNION SECURITY INSURANCE COMPANY | 411 | $208K |
| Vision | ADVANTICA REINSURANCE COMPANY | 420 | $28K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 694 | $452K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 694 | $452K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 694 | $452K |
| Other(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 694 | $483K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 694 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.