| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS INC | 1105 NIKKI VIEW DR BRANDON, FL 33511 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 10.00% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS | 1105 NIKKI VIEW DRIVE BRANDON, FL 33511 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | — | $8K | 20.00% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS | 1105 NIKKI VIEW DR BRANDON, FL 33511 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 5.00% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS | 1105 NIKKI VIEW DRIVE BRANDON, FL 33511 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 20.00% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFIT DBA SULLIVAN | 1105 NIKKI VIEW DRIVE BRANDON, FL 33511 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $946 | — | $946 | 7.44% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS DBA SULLIVAN BENEF | 1105 NIKKI VIEW DRIVE BRANDON, FL 33511 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $312 | — | $312 | 2.45% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS INC | 1105 NIKKI VIEW DR BRANDON, FL 33511 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $608 | — | $608 | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 CLAIMS ADM | Direct payment from the plan; Claims processing; Participant communication; Contract Administrator; Non-monetary compensation; Other services; Named fiduciary; Float revenue Service code 12 | — | $58K |
| REFINED BENEFITS INC BROKER | Other commissions Service code 55 | 1105 NIKKI VIEW DR BRANDON, FL 33511 | $34K |
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 | 257 | 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) | 258 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 171 | $231K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 177 | $70K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 221 | $13K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 259 | $4K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 93 | $38K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 86 | $32K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 171 | $231K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 259 | $23K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 259 | — |
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.