| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| REFINED BENEFITS DBA SULLIVAN3 | 10672 BLOOMINGDALE AVE SUITE 102 RIVERVIEW, FL 33578 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $10K | $10K | 1.39% |
| REFINED BENEFITS DBA SULLIVAN3 | 10672 BLOOMINGDALE AVE SUITE 102 RIVERVIEW, FL 33578 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 0.69% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS | 10672 BLOOMINGTON AVE SUITE 102 RIVERVIEW, FL 33578 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | — | $5K | $5K | 3.70% |
| REFINED BENEFITS DBA SULLIVAN3 | 10672 BLOOMINGDALE AVE SUITE 102 RIVERVIEW, FL 33578 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $486 | — | $486 | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MERITAIN HEALTH EIN 16-1264154 TPA,MED MANAGE, UR | Contract Administrator; Claims processing; Named fiduciary Service code 12 | — | $210K |
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 | 400 | 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) | 401 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 243 | $135K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 213 | $5K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 456 | $277K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 456 | $277K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 456 | $277K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 294 | $726K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 456 | $277K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 456 | — |
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.