| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEIFTS | 1105 NIKKIN VIEW BRANDEN, FL 33511 | CIGNA HEALTH AND LIFE INSURANCE COMPANIES | $56K | — | $56K | 15.66% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS INC | 1105 NIKKI VIEW DR BRANDEN, FL 33511 | GUARDIAN | $13K | $900 | $14K | 10.67% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS | 1105 NIKKI VIEW DRIVE BRANDEN, FL 335114879 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $14K | $603 | $15K | 12.22% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS - SEE ATTACHMENT | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $20K | $1K | $21K | 21.72% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA EIN 59-1031071 CLAIMS ADMINISTRATION | Shareholder servicing fees; Direct payment from the plan; Named fiduciary; Claims processing; Other services; Participant communication; Float revenue; Non-monetary compensation; Contract Administrator Service code 12 | — | $255K |
| REFINED BENEFITS EIN 59-3652048 BROKER | Insurance agents and brokers Service code 22 | — | $71K |
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 | 352 | 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) | 354 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | GUARDIAN | 229 | $135K |
| Vision | GUARDIAN | 229 | $135K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 352 | $121K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 352 | $121K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 352 | $121K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANIES | 391 | $357K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 352 | $217K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 391 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.