| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS INC | 1105 NIKKI VIEW DR BRANDON, FL 335114879 | HUMANA MEDICAL PLAN INC | $54K | — | $54K | 10.00% |
| ROGER BOUCHARD INSURANCE INC3 Filed as: ROGER BOUCHARD INS INC | PO BOX 6090 CLEARWATER, FL 337586090 | HUMANA MEDICAL PLAN INC | $47K | $811 | $48K | 8.82% |
| ROGER BOUCHARD INSURANCE INC3 Filed as: ROGER BOUCHARD INS INC | 101 STARCREST DRIVE CLEARWATER, FL 33511 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $8K | — | $8K | 5.42% |
| 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 | 4.58% |
| ROGER BOUCHARD INSURANCE INC3 Filed as: ROGER BOUCHARD INS INC | 101 N STARCREST DR CLEARWATER, FL 33765 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $179 | $4K | 8.12% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS | 1105 NIKKI VIEW DR BRANDON, FL 33511 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $168 | $4K | 7.63% |
| ROGER BOUCHARD INSURANCE INC3 Filed as: ROGER BOUCHARD INS INC | 101 N STARCREST DR CLEARWATER, FL 33765 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $312 | $7K | 23.76% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS | 1105 NIKKIN VIEW DRIVE BRANDON, FL 33511 | UNUM LIFE INSURANCE COMPANY OF AMERICA | -$2K | -$105 | -$2K | -8.01% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS | 1105 NIKKI VIEW DR BRANDON, FL 33511 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $93 | $2K | 8.62% |
| ROGER BOUCHARD INSURANCE INC3 Filed as: ROGER BOUCHARD INS INC | 101 N STARCREST DR CLEARWATER, FL 33765 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $80 | $2K | 7.31% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HUMANA HEALTH PLAN INC EIN 61-1013183 CLAIMS ADMINISTRATOR | Claims processing; Contract Administrator; Insurance services Service code 12 | — | $513K |
| REFINED BENEFITS BROKER | Insurance agents and brokers Service code 22 | 1105 NIKKI VIEW DRIVE BRANDON, FL 33511 | $54K |
| ROGER BOUCHARD INS INC BROKER | Insurance agents and brokers Service code 22 | PO BOX 6090 CLEARWATER, FL 337586090 | $47K |
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 | 521 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 528 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HUMANA MEDICAL PLAN INC | 281 | $539K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 374 | $156K |
| Vision | HUMANA MEDICAL PLAN INC | 281 | $539K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 521 | $69K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 136 | $28K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 521 | $46K |
| Prescription drug | HUMANA MEDICAL PLAN INC | 281 | $539K |
| Stop-loss / reinsurancereinsurance | HUMANA MEDICAL PLAN INC | 281 | $539K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 521 | $69K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 521 | — |
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.