| 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 | $42K | — | $42K | 10.00% |
| UMR, INC.5 Filed as: UMR | 5151 PFEIFFER RD ML 400 PFEIFFER WOODS CINCINNATI, OH 45242 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $2K | $2K | 0.58% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS INC | 1105 NIKKI VIEW DR BRANDON, FL 33511 | SUN LIFE ASSURANCE COMPANY OF CANADA | $16K | — | $16K | 10.00% |
| MEDICAL GROUP INSURANCE SERVICES5 Filed as: MEDICAL GROUP INSURANCE SVCS INC | 111 SOUTH MAIN STREET SUITE 800 SALT LAKE CITY, UT 841112176 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $195 | $195 | 0.12% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS INC | 1105 NIKKI VIEW DR BRANDON, FL 33511 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 4.33% |
| VARIOUS - SEE ATTACHED3 Filed as: AFLAC - SEE ADDENDUM LISTING | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $28K | $2K | $29K | 24.18% |
| REFINED BENEFITS DBA SULLIVAN3 | 1105 NIKKI VIEW DR BRANDON, FL 33511 | PRINCIPAL LIFE INSURANCE COMPANY | $1K | — | $1K | 4.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX, INC. EIN 33-0441200 PHARMACY BENEFIT MANAGEM | Float revenue; Other fees; Claims processing; Direct payment from the plan Service code 12 | — | $367K |
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSOR | Claims processing Service code 12 | — | $307K |
| REFINED BENEFITS, INC. DBA SULLIVAN EIN 59-3652048 INS BROKER | Other commissions Service code 55 | 1105 NIKKI VIEW DR BRANDON, FL 33511 | $72K |
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 | 419 | 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) | 420 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | SUN LIFE ASSURANCE COMPANY OF CANADA | 380 | $418K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 299 | $147K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 299 | $147K |
| Life insurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 419 | $196K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 419 | $161K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 380 | $418K |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 419 | $283K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 419 | — |
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.