| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS INC DBA SULLIVAN | 10672 BLOOMINGDALE AVE SUITE 102 RIVERVIEW, FL 33578 | SUN LIFE ASSURANCE COMPANY OF CANADA | $46K | $7K | $53K | 10.41% |
| UMR, INC.3 | 11 SCOTT ST SUITE 100 WAUSAU, WI 54403 | 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 | $6K | $6K | $12K | 8.31% |
| VARIOUS - SEE ATTACHED3 Filed as: AFLAC - SEE ADDENDUM LISTING | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $31K | $2K | $34K | 22.93% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS INC | 10672 BLOOMINGDALE AVE STE 102 RIVERVIEW, FL 33578 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $9K | — | $9K | 10.00% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS INC | 10672 BLOOMINGDALE AVE SUITE 102 RIVERVIEW, FL 33578 | SUN LIFE ASSURANCE COMPANY OF CANADA | $3K | — | $3K | 8.15% |
| MEDICAL GROUP INSURANCE SERVICES5 Filed as: MEDICAL GROUP INSURANCE SVCS INC | 111 SOUTH MAIN STREET SUITE 400 SALT LAKE CITY, UT 841112176 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $165 | $165 | 0.47% |
| REFINED BENEFITS DBA SULLIVAN3 | 1105 NIKKI VIEW DR BRANDON, FL 33511 | PRINCIPAL LIFE INSURANCE COMPANY | $1K | — | $1K | 7.80% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSOR | Claims processing Service code 12 | — | $257K |
| REFINED BENEFITS, INC. DBA SULLIVAN EIN 59-3652048 INS BROKER | Other commissions Service code 55 | 10672 BLOOMINGDALE AVE RIVERVIEW, FL 33578 | $82K |
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 | 514 | 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) | 515 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | SUN LIFE ASSURANCE COMPANY OF CANADA | 428 | $505K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 363 | $149K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 363 | $149K |
| Life insurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 514 | $54K |
| Long-term disability(2 contracts, 2 carriers) | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 514 | $127K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 428 | $505K |
| Other(3 contracts, 3 carriers) | AFLAC | 514 | $191K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 514 | — |
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.