| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS INC DBA SULLIVAN | 1105 NIKKI VIEW DR BRANDON, FL 33511 | SUN LIFE ASSURANCE COMPANY OF CANADA | $55K | — | $55K | 9.55% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS INC | 1105 NIKKI VIEW DR BRANDON, FL 33511 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $34K | $8K | $42K | 12.35% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS | 1105 NIKKI VIEW DR BRANDON, FL 33511 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $10K | $2K | $11K | 5.35% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS | 1105 NIKKI VIEW DR BRANDON, FL 33511 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $11K | $583 | $12K | 16.87% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS | 1105 NIKKI VIEW DR BRANDON, FL 33511 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $257 | $5K | 17.09% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS | 1105 NIKKI VIEW DR BRANDON, FL 33511 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $137 | $3K | 16.03% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX INC EIN 33-0441200 PHARMACY BENEFIT MGMT. | Other fees; Float revenue; Direct payment from the plan; Claims processing Service code 12 | — | $721K |
| UMR EIN 39-1995276 CLAIMS ADMINISTRATOR | Claims processing Service code 12 | — | $204K |
| REFINED BENEFITS EIN 59-3652048 INS BROKER | Other commissions Service code 55 | DBA SULLIVAN BENEFITS 1105 NIKKI VIEW DR BRANDON, FL 33511 | $40K |
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 | 413 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 415 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 357 | $596K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 416 | $339K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 416 | $339K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 420 | $100K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 413 | $215K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 413 | $215K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 357 | $578K |
| Other(3 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 420 | $117K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 420 | — |
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.