| 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 | $43K | $4K | $48K | 11.01% |
| UMR, INC.5 Filed as: UMR | 5151 PFEIFFER RD ML 400 PFEIFFER WOODS CINCINNATI, OH 45242 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $3K | $3K | 0.64% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS INC | 1105 NIKKI VIEW DR BRANDON, FL 33511 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 4.91% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS INC | 1105 NIKKI VIEW DR BRANDON, FL 33511 | SUN LIFE ASSURANCE COMPANY OF CANADA | $13K | — | $13K | 10.00% |
| MEDICAL GROUP INSURANCE SERVICES5 Filed as: MEDICAL GROUP INSURANCE SVCS INC | 10 WEST BROADWAY SUITE 800 SALT LAKE CITY, UT 841012100 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $165 | $165 | 0.13% |
| VARIOUS - SEE ATTACHED3 Filed as: AFLAC - SEE ADDENDUM LISTING | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $19K | $27 | $19K | 20.44% |
| REFINED BENEFITS DBA SULLIVAN3 | 1105 NIKKI VIEW DR BRANDON, FL 33511 | PRINCIPAL LIFE INSURANCE COMPANY | $1K | — | $1K | 3.60% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIM PROCESSOR | Claims processing; Contract Administrator Service code 12 | — | $266K |
| REFINED BENEFITS, INC. DBA SULLIVAN EIN 59-3652048 INS BROKER | Other commissions Service code 55 | 1105 NIKKI VIEW DR BRANDON, FL 33511 | $66K |
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 | 422 | 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) | 424 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | SUN LIFE ASSURANCE COMPANY OF CANADA | 357 | $434K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 286 | $139K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 286 | $139K |
| Life insurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 422 | $164K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 422 | $129K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 357 | $434K |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 422 | $224K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 422 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.