| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS INC/OSEPH SULLIVAN | 1105 NIKKI VIEW DRIVE BRANDON, FL 33511 | BLUE CROSS BLUE SHIELD OF FLORIDA | $31K | — | $31K | 5.00% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS INC | 1105 NIKKI VIEW DR BRANDON, FL 335114879 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $9K | $2K | $11K | 14.12% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS INC | 1105 NIKKI VIEW DR BRANDON, FL 33511 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $5K | $2K | $7K | 13.51% |
| HARRISON-DAVIS INC4 | 5426 BAY CENTER DR SUITE 550 TAMPA, FL 33609 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $97 | — | $97 | 0.20% |
| DEBORAH P BLACK3 | 5509 FORESTER POND AVE SARASOTA, FL 34243 | AFLAC | $2K | $139 | $2K | 10.40% |
| JOAN A FARNHAM3 | 5138 39TH ST W BRADENTON, FL 34210 | AFLAC | $446 | $33 | $479 | 2.50% |
| BARTLEIN AND ASSOC INC3 Filed as: BARTLEIN & ASSOCS INC | 5577 BROADCAST CT LAKEWOOD RANCH, FL 34240 | AFLAC | $309 | $33 | $342 | 1.78% |
| SYLVESTER SAWYER3 | 1181 S SUMTER BLVD #410 NORTHPORT, FL 34287 | AFLAC | $158 | — | $158 | 0.82% |
| G SCOTT COOKE3 Filed as: SCOTT C BLACK | 5509 FORESTER POND AVE SARASOTA, FL 34243 | AFLAC | $138 | $9 | $147 | 0.77% |
| MARJORIE W DECANIO3 | 2803 FRUITVILLE RD STE 120 SARASOTA, FL 34237 | AFLAC | $118 | — | $118 | 0.61% |
| CHARMAINE K HAYDEN3 | 3908 MAVERICK AVE SARASOTA, FL 34233 | AFLAC | $99 | $17 | $116 | 0.60% |
| MARY BARTLEIN3 | 5577 BROADCAST COURT SARASOTA, FL 34240 | AFLAC | $95 | — | $95 | 0.49% |
| SUSAN C BRIMHALL3 | 155 CYPRESS LN SUITE 525 OLDSMAR, FL 34677 | AFLAC | $41 | $33 | $74 | 0.39% |
| JOHN J GRUND3 | 4119 24TH AVE W BRADENTON, FL 34205 | AFLAC | $40 | — | $40 | 0.21% |
| MARY REBECCA WEATHERLY3 | 1934 E LEEWYN DR SARASOTA, FL 34240 | AFLAC | $36 | — | $36 | 0.19% |
| RAM 1 INC3 | 1108 67TH ST CT E BRADENTON, FL 34208 | AFLAC | $35 | — | $35 | 0.18% |
| JUSTIN M REYNOLDS3 | 8433 ENTERPRISE CIR STE 100 LAKEWOOD RANCH, FL 34202 | AFLAC | $35 | — | $35 | 0.18% |
| CHRISTINE P HORNE3 | 32245 DARTMOUTH LN SARASOTA, FL 34239 | AFLAC | $31 | — | $31 | 0.16% |
| ROBERT J HORNE3 | 3224 DARTMOUTH LN SARASOTA, FL 34239 | AFLAC | $23 | — | $23 | 0.12% |
| JAMES (JAY) GRIMES3 Filed as: JAMES JAY GRIMES | 4272 PERSIMMON WOODS DR NORTH CHARLESTON, SC 29420 | AFLAC | $18 | — | $18 | 0.09% |
| ROGER BOUCHARD INSURANCE INC3 Filed as: ROGER BOUCHARD INS AGCY | PO BOX 6090 101 STARCREST DR CLEARWATER, FL 33758 | AFLAC | $14 | — | $14 | 0.07% |
| J W GRIMES INC3 | 7659 HERITAGE CROSSING WAY REUNION, FL 34747 | AFLAC | $5 | — | $5 | 0.03% |
| GRAVES INC3 | 5336 CAPTAINS CT NEW PORT RICHEY, FL 34652 | AFLAC | $3 | — | $3 | 0.02% |
No Schedule C service providers reported on this filing.
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 | 119 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 122 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF FLORIDA | 114 | $622K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 98 | $48K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 135 | $75K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 135 | $75K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 135 | $75K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 135 | $94K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 135 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.