| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| REFINED BENEFITS DBA SULLIVAN3 | 1105 NIKKI VIEW DR BRANDON, FL 33511 | SUN LIFE ASSURANCE COMPANY OF CANADA | $54K | — | $54K | 10.00% |
| UMR, INC.3 | 11 SCOTT ST, STE 100 WAUSAU, WI 54403 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $3K | $3K | 0.53% |
| REFINED BENEFITS DBA SULLIVAN3 | 1105 NIKKI VIEW DR BRANDON, FL 335114879 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $29K | $11K | $40K | 20.69% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS INC | 1105 NIKKI VIEW DR BRANDON, FL 33511 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $9K | $3K | $12K | 13.87% |
| REFINED BENEFITS DBA SULLIVAN3 | 1105 NIKKI VIEW DR BRANDON, FL 335114879 | HUMANA INSURANCE COMPANY | $2K | — | $2K | 10.89% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SUN LIFE ASSURANCE COMPANY OF CANAD EIN 38-1082080 STOP LOSS INSURER | Insurance services Service code 23 | — | $543K |
| UMR INC EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $192K |
| REFINED BENEFITS INC EIN 59-3652048 HLTH BROKER | Other commissions Service code 55 | 1105 NIKKI VIEW DR BRANDON, FL 33511 | $48K |
| MEDCOM BENEFIT SOLUTIONS EIN 59-2316866 HRA ADMIN | Claims processing; Contract Administrator Service code 12 | — | $14K |
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 | 306 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 309 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | SUN LIFE ASSURANCE COMPANY OF CANADA | 255 | $545K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 166 | $86K |
| Vision | HUMANA INSURANCE COMPANY | 157 | $17K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 306 | $195K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 306 | $195K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 306 | $195K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 255 | $545K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 306 | $195K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 306 | — |
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.