| 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 AND AFFILIATES | $58K | — | $58K | 16.16% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS INC | 1105 NIKKI VIEW DR BRANDEN, FL 33511 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $13K | $5K | $19K | 13.88% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS | 10672 BLOOMINGDALE AVE STE 102 RIVERVIEW, FL 33578 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $14K | — | $14K | 11.71% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS | 1105 NIKKI VIEW DR BRANDEN, FL 33511 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $7K | $7K | 6.22% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS - SEE ATTACHMENT | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $12K | $611 | $12K | 14.31% |
| THE JOSEPH AGENCY INC.4 | 314 WICKHAM CT LONGWOOD, CT 32779 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $3K | — | $3K | 32.40% |
| LAROCCA AND ASSOCIATES INC4 Filed as: LAROCCA & ASSOCIATES INC | 3696 N FEDERAL HWY STE 202 FORT LAUDERSALE, FL 33308 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $41 | — | $41 | 0.40% |
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 | 349 | 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) | 350 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 215 | $134K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 215 | $134K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 338 | $116K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 338 | $116K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 338 | $116K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANIES AND AFFILIATES | 380 | $358K |
| Other(3 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 338 | $211K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 380 | — |
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.