| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| REFINED BENEFITS DBA SULLIVAN3 | 1105 NIKKI VIEW DR BRANDON, FL 33511 | MUTUAL OF OMAHA LIFE INSURANCE COMPANY | $15K | $2K | $18K | 17.07% |
| REFINED BENEFITS DBA SULLIVAN3 Filed as: REFINED BENEFITS INC | 1105 NIKKI VIEW DR BRANDON, FL 33511 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $8K | $4K | $12K | 14.47% |
| KEVIN CHAMBERS3 | 9764 1ST ST N ST PETERSBURG, FL 33702 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $12K | — | $12K | 16.47% |
| B AVERY ENTERPRISES INC3 Filed as: B AVERY ENTERPRISES I9NC | 4085 HANCOCK BRIDGE PKWY STE 116 NORTH FT MYERS, FL 33903 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $8K | — | $8K | 11.42% |
| MICHELLE REMBERTA LOCICERO3 | 4447 ASHTON MEADOWS WAY WESLEY CHAPEL, FL 33543 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $6K | — | $6K | 8.02% |
| ROBERT M GLASS CORP3 | 1600 S FEDERAL HWY STE 801-D POMPANO BEACH, FL 33062 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $5K | — | $5K | 7.28% |
| REFINED BENEFITS DBA SULLIVAN3 | 1105 NIKKI VIEW DR BRANDON, FL 33511 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $2K | — | $2K | 2.30% |
| REFINED BENEFITS DBA SULLIVAN3 | 1105 NIKKI VIEW DR BRANDON, FL 33511 | ADVANTICA REINSURANCE COMPANY | $2K | — | $2K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR INC EIN 39-1995276 CLAIMS PROCESSOR | Claims processing Service code 12 | — | $196K |
| REFINED BENEFITS INC DBA SULLIVAN EIN 59-3652048 BROKER | Other commissions Service code 55 | 1105 NIKKI VIEW DR BRANDON, FL 33511 | $49K |
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 | 341 | 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) | 345 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 243 | $85K |
| Vision | ADVANTICA REINSURANCE COMPANY | 278 | $22K |
| Life insurance | MUTUAL OF OMAHA LIFE INSURANCE COMPANY | 341 | $103K |
| Short-term disability | MUTUAL OF OMAHA LIFE INSURANCE COMPANY | 341 | $103K |
| Long-term disability | MUTUAL OF OMAHA LIFE INSURANCE COMPANY | 341 | $103K |
| Other(2 contracts, 2 carriers) | MUTUAL OF OMAHA LIFE INSURANCE COMPANY | 341 | $175K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 341 | — |
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.