| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| REFINED BENEFITS DBA SULLIVAN3 | 1105 NIKKI VIEW DR BRANDON, FL 33511 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $4K | $4K | 1.14% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS INC | 1105 NIKKI VIEW DR BRANDON, FL 33511 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $11K | $513 | $12K | 19.12% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS INC | 1105 NIKKI VIEW DR BRANDON, FL 335114879 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | — | $3K | 4.59% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS INC | 1105 NIKKI VIEW DR BRANDON, FL 33511 | ADVANTICA INSURANCE COMPANY | $875 | — | $875 | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 ASO HLTH PROVIDER | Contract Administrator; Other services; Named fiduciary; Float revenue; Claims processing; Other commissions; Direct payment from the plan; Non-monetary compensation; Participant communication Service code 12 | — | $141K |
| QUEST DIAGNOSTICS EIN 38-2084239 WELLNESS PROVIDER | Other services Service code 49 | — | $8K |
| BENEFIT SOLUTIONS INC HRA SERVICE PROVIDER | Claims processing; Contract Administrator Service code 12 | PO BOX 181427 CASSELBERRY, FL 327181427 | $5K |
| CIGNA HEALTH AND LIFE INSURANCE COM | Contract Administrator; Float revenue; Direct payment from the plan; Non-monetary compensation; Other services; Named fiduciary; Claims processing; Participant communication Service code 12 | — | $0 |
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 | 262 | 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) | 264 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 307 | $368K |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 501 | $58K |
| Vision | ADVANTICA INSURANCE COMPANY | 284 | $9K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 116 | $61K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 116 | $61K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 116 | $61K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 307 | $368K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 116 | $61K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 501 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.