Form 5500 · Employee benefit plan · CORINTH, MS
REFRESHMENTS, INC.
The filing calls this plan REFRESHMENTS, INC. WELFARE PLAN.
REFRESHMENTS, INC. of CORINTH, MS insures health, dental, vision, life and disability coverage for its employees, per Schedule A of its Form 5500. Its broker of record is JACKIE HOLT. Coverage is written through BLUE CROSS & BLUE SHIELD OF MISSISSIPPI and 2 other carriers. The plan's most recent policy period ended in October.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 64-0434956 · plan 501 · plan year 2025, filed Jul 10, 2026
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How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
Benefits declared on this filing
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 3 insured contracts covering health, dental, vision, life and disability; the largest, with BLUE CROSS & BLUE SHIELD OF MISSISSIPPI, covers 120 people.
Reported premium across the insured contracts is $632,046, with $51,758 in disclosed broker commissions — about 8.2% of premium.
The health contract's policy period ended in October, while at least one ancillary line's policy period ended in December. The plan is on a split renewal cycle.
JACKIE HOLT is the broker of record on 1 of the 3 contracts; the rest name a different broker or none.
3 carriers appear on the filing, including BLUE CROSS & BLUE SHIELD OF MISSISSIPPI, THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA and TOKIO MARINE HCC. BLUE CROSS & BLUE SHIELD OF MISSISSIPPI writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| BLUE CROSS & BLUE SHIELD OF MISSISSIPPI | Health | 120 | Oct 4, 2025 | $358,992 | $18,819 |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | Dental, Vision, Life, Disability | 108 | Jan 1, 2026 | $153,924 | $16,557 |
| TOKIO MARINE HCC | Health | 93 | Apr 1, 2025 | $119,130 | $16,382 |
Premium and claims on this contract
BLUE CROSS & BLUE SHIELD OF MISSISSIPPI, contract 012152. For the contract year on this filing, the carrier reported $358,992 in premium earned and $446,489 in claims incurred. Dividing one by the other gives 124%.
- BLUE CROSS & BLUE SHIELD OF MISSISSIPPI, contract 012152 reported $54,718 in retention.
Retention is what the carrier kept of the premium after claims, as reported: administration, commissions and other charges.
Only experience-rated contracts report these figures, so most filings leave them blank.
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Reported to OSHA
Reported to OSHA for 2025: 129 employees, 1 recordable cases, 0 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
How this plan compares
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