| 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 | $18K | $8K | $26K | 17.84% |
| DIGITAL INSURANCE LLC3 | 1105 NIKKI VIEW DR BRANDON, LA 33511 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $8K | — | $8K | 8.01% |
| DIGITAL INSURANCE LLC3 | 200 GALLERIA PARKWAY ST. SUITE 1950 ATLANTA, GA 303395946 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | $3K | $5K | 5.49% |
| REFINED BENEFITS DBA SULLIVAN3 | 10672 BLOOMINGDALE AVENUE SUITE 102 RIVERVIEW, FL 33578 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $2K | — | $2K | 8.13% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC. | 200 GALLERIA PARKWAY ST. SUITE 1950 ATLANTA, GA 303395946 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $410 | — | $410 | 1.87% |
| DIGITAL INSURANCE LLC3 | 200 GALLERIA PARKWAY ST. SUITE 1950 ATLANTA, GA 303395946 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $64 | $1K | 17.43% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA EIN 59-1031071 CLAIMS ADMIN | Contract Administrator; Non-monetary compensation; Direct payment from the plan; Other services; Participant communication; Named fiduciary; Claims processing; Float revenue Service code 12 | — | $238K |
| REFINED BENEFITS DBA SULLIVAN EIN 59-3652048 BROKER | Other commissions Service code 55 | 1105 NIKKI VIEW DR BRANDON, FL 33511 | $60K |
| DIGITAL INURANCE INC. BROKER | Other commissions Service code 55 | 200 GALLERIA PARKWAY SUITE 1950 ATLANTA, GA 30339 | $5K |
| CIGNA HEALTH & LIFE INSURANCE CO | Participant communication; Contract Administrator; Claims processing; Named fiduciary; Other services; Non-monetary compensation; Direct payment from the plan; Float revenue 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 | 184 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 188 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 145 | $98K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 126 | $22K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 194 | $148K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 10 | $8K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 194 | $148K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 194 | — |
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.