| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| REFINED BENEFITS DBA SULLIVAN3 | 10672 BLOOMINGDALE AVE STE 102 RIVERVIEW, FL 33578 | SUN LIFE ASSURANCE COMPANY OF CANADA | $77K | $19K | $96K | 13.24% |
| REFINED BENEFITS DBA SULLIVAN3 | 10672 BLOOMINGTON AVE STE 102 RIVERVIEW, FL 33578 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $31K | $12K | $43K | 20.68% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS INC | 1105 NIKKI VIEW DR BRANDON, FL 33511 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $12K | $5K | $17K | 13.84% |
| SEE ATTACHED LIST3 | P. O. BOX 1365 COLUMBIA, SC 292021365 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10K | $442 | $10K | 15.86% |
| SEE ATTACHED LIST3 | — | AFLAC | $4K | $174 | $4K | 11.88% |
| REFINED BENEFITS DBA SULLIVAN3 | 1105 NIKKI VIEW DR BRANDON, FL 335114879 | HUMANA INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MERITAIN HEALTH EIN 16-1244154 UTILIZATION REVIEW | Claims processing; Other commissions Service code 12 | — | $252K |
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 | 315 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 316 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | SUN LIFE ASSURANCE COMPANY OF CANADA | 259 | $724K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 177 | $120K |
| Vision | HUMANA INSURANCE COMPANY | 159 | $17K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 318 | $210K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 318 | $210K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 318 | $210K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 259 | $724K |
| Other(3 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 318 | $310K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 318 | — |
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.