| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLANT RISK & INSURANCE SERVICES3 Filed as: GALLANT RISK & INS. SERVICES INC | PO BOX 55127 RIVERSIDE, CA 92517 | STANDARD INSURANCE COMPANY | $9K | — | $9K | 7.39% |
| JOHN D EVANGELISTA3 | 26111 ANTONIO PARKWAY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $1K | $5K | 6.16% |
| ADRIANA MENDIETA3 | 29448 TOURS STREET LAKE ELSINORE, CA 92530 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $432 | $2K | 2.35% |
| GALLANT RISK & INSURANCE SERVICES3 | 4160 TEMESCAL CANYON RD CORONA, CA 92883 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 2.13% |
| SHERMAN PARENT PRINCE & FLEMING3 | C/O INVENSURE INSURANCE IRVINE, CA 92614 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 1.85% |
| RAMONA MARGARET DALY3 | 402 CAMINO BANDERA SAN CLEMENTE, CA 92673 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $805 | — | $805 | 0.95% |
| LUIS ERNESTO PEREZ3 | 861 KENWOOD ST UPLAND, CA 91784 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $651 | $94 | $745 | 0.88% |
| SUSAN GOLD STOKES3 Filed as: SUSAN G STOKES | 3113 W 187TH PI TORRANCE, CA 90504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $557 | $84 | $641 | 0.76% |
| UZIEL RIVERA3 | 543 CHEROKEE CIR BANNING, CA 92220 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $377 | $111 | $488 | 0.58% |
| GABRIEL HOLGUIN3 | 26342 FOREST BRIDGE DR LAKE FOREST, CA 92630 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $381 | $67 | $448 | 0.53% |
| ZACHARY MULLINS3 | 39 COMMENTRY DR LITTLE ROCK, AR 72223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $254 | $71 | $325 | 0.38% |
| MIKE MCCORMICK3 | 348 S STRONGS CT SALT LAKE CITY, UT 84102 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $253 | — | $253 | 0.30% |
| MARIA YVONNE RODIGHIERO3 | 28502 SHRIKE DRIVE LAGUNA NIGUEL, CA 92677 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $244 | — | $244 | 0.29% |
| STEPHEN W DOUGLASS3 | 45 MORNING GLORY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $197 | $4 | $201 | 0.24% |
| REGINA SWINNEA3 | 611 E LOOP 499 HARLINGEN, TX 78550 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $143 | $12 | $155 | 0.18% |
| MARIA C GONZALEZ3 | 11677 SANDPIPER CT MORENO VALLEY, CA 92557 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $116 | $18 | $134 | 0.16% |
| LAMBERT MONTALBO3 | 26197 MIRADA ST HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $92 | $6 | $98 | 0.12% |
| RYAN THURSTON WHITTAKER3 | 330011 COMMODORE CT SAN JUAN CAPO, CA 92675 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $67 | — | $67 | 0.08% |
| MICHAEL C WALKER3 Filed as: MICHAEL J MINNEY | PO BOX 365 POWAY, CA 92074 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $52 | — | $52 | 0.06% |
| GINGER MULLINS & COMPANY INC3 | 1701 CENTERVIEW DRIVE LITTLE ROCK, AR 72211 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $38 | $7 | $45 | 0.05% |
| METRO COAST INSURANCE SERVICES LLC3 | 39 AUBRIETA RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $31 | — | $31 | 0.04% |
| ARIADNE DE BASABE-MACHICHE3 | 1102 NIMROD CIRCLE CORONA, CA 92880 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $26 | $4 | $30 | 0.04% |
| DELORES J KARISCH3 | PO BOX 40752 HOUSTON, TX 77240 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $25 | — | $25 | 0.03% |
| SALAZAR INSURANCE GROUP LLC3 | 611 E LOOP 499 HARLINGEN, TX 78550 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $11 | $12 | $23 | 0.03% |
| CLAUDIA MARABOTO3 | 130 TIERRA MONTANOSA RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $14 | — | $14 | 0.02% |
| DONNA SWINNEA3 | 611 E LOOP 499 HARLINGEN, TX 78550 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $11 | — | $11 | 0.01% |
| RONALD PERALEZ3 | 18 SEPULVEDA RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.01% |
| JORGE RIESTRA3 | 2800 KELLER DR TUSTIN CITY, CA 92782 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.01% |
| ERIC BROGAN3 Filed as: ERIC SWANSON | 32101 FALL RIVER ROAD TRABUCO CANYON, CA 92679 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.00% |
| G SCOTT COOKE3 Filed as: SCOTT C CASTEEL | 1450 WEST JAMES WAY ANAHEIM, CA 92801 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.00% |
| BRAD SCOFFIN3 | 7931 TS AVENUE EAST SCOTTS, MI 49088 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| GALLANT RISK & INSURANCE SERVICES INSURANCE AGENT | Insurance services; Insurance agents and brokers Service code 22 | 4160 TEMESCAL CANYON ROAD, STE 402 CORONA, CA 92883 | $86K |
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 | 290 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 5 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 298 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 296 | $2.8M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 296 | $2.8M |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 296 | $2.8M |
| Life insurance(2 contracts, 2 carriers) | STANDARD INSURANCE COMPANY | 323 | $206K |
| Short-term disability(2 contracts, 2 carriers) | STANDARD INSURANCE COMPANY | 323 | $206K |
| Long-term disability | STANDARD INSURANCE COMPANY | 323 | $121K |
| 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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.