| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS | 10672 BLOOMINGTON AVE SUITE 102 RIVERVIEW, FL 33578 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $17K | — | $17K | 12.27% |
| REFINED BENEFITS DBA SULLIVAN3 | 1105 NIKKI VIEW DR BRANDON, FL 33511 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $7K | $7K | 5.14% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS INC | 1105 NIKKI VIEW DR BRANDON, LA 33511 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $7K | $4K | $11K | 14.88% |
| REFINED BENEFITS DBA SULLIVAN3 | 1105 NIKKI VIEW DR BRANDON, FL 33511 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $99 | $2K | 15.60% |
| REFINED BENEFITS DBA SULLIVAN3 | 10672 BLOOMINGDALE AVENUE SUITE 102 RIVERVIEW, FL 33578 | ADVANTICA INSURANCE COMPANY | $1K | — | $1K | 8.51% |
| REFINED BENEFITS DBA SULLIVAN3 | 1105 NIKKI VIEW DRIVE BRANDON, LA 33511 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $378 | — | $378 | 9.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA EIN 59-1031071 CLAIMS ADMIN | Non-monetary compensation; Claims processing; Direct payment from the plan; Contract Administrator; Other services; Named fiduciary; Participant communication; Float revenue Service code 12 | — | $253K |
| REFINED BENEFITS INC EIN 59-3652048 BROKER | Other commissions Service code 55 | 1105 NIKKI VIEW DR BRANDON, FL 33511 | $60K |
| CIGNA HEALTH & LIFE INSURANCE CO | Contract Administrator; Non-monetary compensation; Named fiduciary; Participant communication; Claims processing; Other services; Float revenue; Direct payment from the plan Service code 12 | — | $0 |
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 | 239 | 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) | 240 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 176 | $73K |
| Vision(2 contracts, 2 carriers) | ADVANTICA INSURANCE COMPANY | 323 | $17K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 228 | $140K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 12 | $14K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 228 | $140K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 323 | — |
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.