| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BARICH AND ASSOCIATES INSURANCE3 | MARKETING SERVICES 1819 W REDLANDS BLVD# 104 D REDLANDS, CA 92373 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $87K | — | $87K | 5.07% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | LLC 2677 N. MAIN STREET, STE. 800 SANTA ANA, CA 92705 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | — | $38K | $38K | 2.21% |
| DEBRA J SUMPTER3 | PO BOX 9081 SAN BERNARDINO, CA 92427 | AFLAC | $5K | $111 | $5K | 8.07% |
| JANICE M ADAMSON3 | 405 S HIBISCUS WAY ANAHEIM, CA 92808 | AFLAC | $890 | $16 | $906 | 1.50% |
| JOSEPH HOFFMAN3 | 29110 TEMBUSO LAKE ELSINORE, CA 92530 | AFLAC | $563 | — | $563 | 0.93% |
| GUINETH ANN REED3 | 208 FULTON AVE ROCKPORT, TX 78382 | AFLAC | $484 | — | $484 | 0.80% |
| DWAYNE R MARTINEZ3 | 597 W 475 N CLEARFIELD, UT 84015 | AFLAC | $383 | $26 | $409 | 0.68% |
| VALERIE LOGAN3 | 11093 RAYMOND RD MORENO VALLEY, CA 92555 | AFLAC | $382 | $9 | $391 | 0.65% |
| CHRIS FREITAG3 | 432 N PENNSYLVANIA AVE GLENDORA, CA 91741 | AFLAC | $230 | — | $230 | 0.38% |
| JAMIE AMSTUTZ3 | 3755 AVOCADO BLVD 180 LA MESA, CA 91941 | AFLAC | $215 | — | $215 | 0.36% |
| TBURNETT INSURANCE3 | SERVICES LLC 315 KONA LN PALM SPRINGS, CA 92264 | AFLAC | $214 | — | $214 | 0.35% |
| SAHAR QABAZARD3 | 443 S MAPLE DR BEVERLY HILLS, CA 90212 | AFLAC | $90 | — | $90 | 0.15% |
| THE HORTON GROUP3 Filed as: VERNA M HORTON | 2536 FOREST LK SANTA ANA, CA 92705 | AFLAC | $50 | — | $50 | 0.08% |
| TERRANCE M LUCZAJ3 | 27 DIETES CT LADERA RANCH, CA 92694 | AFLAC | $38 | — | $38 | 0.06% |
| JULIUS ROBERT BOTELHO3 | PO BOX 1675 INYOKERN, CA 93527 | AFLAC | $35 | — | $35 | 0.06% |
| GABRIEL R JAUREGUI3 | 7155 CEDAR CREEK RD CORONA, CA 92880 | AFLAC | $29 | — | $29 | 0.05% |
| JONATHAN ALI HAJIMOMEN3 | 5752 WHISTLER CIR HUNTINGTON BEACH, CA 92649 | AFLAC | $23 | — | $23 | 0.04% |
| CHRISTOPHER L. TANG3 Filed as: CHRISTOPHER L TANG | 15155 LEFFINGWELL RD WHITTIER, CA 90604 | AFLAC | $22 | — | $22 | 0.04% |
| JESSICA RENEE GREENE3 Filed as: JESSICA R GREENE | 714 WILLIAMS DR APT B HUNTINGTON BEACH, CA 92648 | AFLAC | $22 | — | $22 | 0.04% |
| DANIEL MARTIN BREDESON3 | 19043 META RD CORNELIUS, NC 28031 | AFLAC | $20 | — | $20 | 0.03% |
| HARRY H SONKE3 | 2258 BLACK OAK PL RIVERSIDE, CA 92506 | AFLAC | $20 | — | $20 | 0.03% |
| TOMMY C FLEESON3 | 3395 MICHELSON DR APT 5155 IRVINE, CA 92612 | AFLAC | $13 | — | $13 | 0.02% |
| G SCOTT COOKE3 | 2832 NE 17TH AVE WILTON MANORS, FL 33334 | AFLAC | $11 | — | $11 | 0.02% |
| JOY E GUNDERSON3 | 2824 SAINT ANDREWS RD FAIRFIELD, CA 94534 | AFLAC | $11 | — | $11 | 0.02% |
| MATTHEW D PAULUS3 | 100 TENNESSEE ST APT 1 REDLANDS, CA 92373 | AFLAC | $9 | — | $9 | 0.01% |
| MARK J WOOD3 | 315 W HACIENDA DR CORONA, CA 92882 | AFLAC | $7 | — | $7 | 0.01% |
| NANCY L BOTELHO3 | PO BOX 1675 INYOKERN, CA 93527 | AFLAC | $6 | — | $6 | 0.01% |
| COLLEEN M LAPRADE3 | 1053 HERMES AVE ENCINITAS, CA 92024 | AFLAC | $6 | — | $6 | 0.01% |
| DAWN T SUCHECKI3 | 225 S WATER ST WILMINGTON, NC 28401 | AFLAC | $6 | — | $6 | 0.01% |
| GCG FINANCIAL LLC3 Filed as: TERRANCE H DICKERSON | PO BOX 8217 REDLANDS, CA 92375 | AFLAC | $6 | — | $6 | 0.01% |
| KEITH A LYNAM3 | 710 N EMMA ST CHRISTOPHER, IL 62822 | AFLAC | $5 | — | $5 | 0.01% |
| SHANE M OWEN3 Filed as: SHANE CRAIG DAVISON | 3013 LARGE HOP LN ANTIOCH, TN 37013 | AFLAC | $4 | — | $4 | 0.01% |
| ANDREW R GRETHEL3 | 11739 HICKORY RUN CT LOVELAND, OH 45140 | AFLAC | $3 | — | $3 | 0.00% |
| BARRY MCPHERSON INC3 | 3928 IRONBARK WAY MCKINNEY, TX 75071 | AFLAC | $2 | — | $2 | 0.00% |
| DALE IRA DAVIS3 | 5892 CEDARCREEK LN LEXINGTON, KY 40515 | AFLAC | $2 | — | $2 | 0.00% |
| OWEN JOHNSTON3 | 1300 FAIRHAVEN AVE APT 3 SANTA ANA, CA 92705 | AFLAC | $2 | — | $2 | 0.00% |
| JEFFREY T JOHNSON3 | 30766 MAINMAST DR AGOURA HILLS, CA 91301 | AFLAC | $1 | — | $1 | 0.00% |
| DEBRA J SUMPTER3 | PO BOX 9081 SAN BERNARDINO, CA 92427 | AFLAC | $6K | — | $6K | 11.75% |
| JANICE M ADAMSON3 | 405 S HIBISCUS WAY ANAHEIM, CA 92808 | AFLAC | $837 | — | $837 | 1.52% |
| VALERIE LOGAN3 | 11093 RAYMOND RD MORENO VALLEY, CA 92555 | AFLAC | $800 | — | $800 | 1.45% |
| JOSEPH HOFFMAN3 | 29110 TEMBUSO LAKE ELSINORE, CA 92530 | AFLAC | $444 | — | $444 | 0.80% |
| TBURNETT INSURANCE3 | SERVICES LLC 315 KONA LN PALM SPRINGS, CA 92264 | AFLAC | $392 | — | $392 | 0.71% |
| DWAYNE R MARTINEZ3 | 597 W 475 N CLEARFIELD, UT 84015 | AFLAC | $376 | — | $376 | 0.68% |
| JAMIE AMSTUTZ3 | 3755 AVOCADO BLVD 180 LA MESA, CA 91941 | AFLAC | $291 | — | $291 | 0.53% |
| GUINETH ANN REED3 | 208 FULTON AVE ROCKPORT, TX 78382 | AFLAC | $164 | — | $164 | 0.30% |
| SUSAN C. HAMA3 Filed as: SUSAN C HAMA | 7778 PASEO LA JOLLA CARLSBAD, CA 92009 | AFLAC | $140 | — | $140 | 0.25% |
| TERRANCE M LUCZAJ3 | 27 DIETES CT LADERA RANCH, CA 92694 | AFLAC | $60 | — | $60 | 0.11% |
| JOY E GUNDERSON3 | 2824 SAINT ANDREWS RD FAIRFIELD, CA 94534 | AFLAC | $18 | — | $18 | 0.03% |
| TOMMY C FLEESON3 | 3395 MICHELSON DR APT 5155 IRVINE, CA 92612 | AFLAC | $18 | — | $18 | 0.03% |
| JULIE L WOLD3 | 7720 E MOONRIDGE LN ANAHEIM, CA 92808 | AFLAC | $18 | — | $18 | 0.03% |
| SAHAR QABAZARD3 | 443 S MAPLE DR BEVERLY HILLS, CA 90212 | AFLAC | $10 | — | $10 | 0.02% |
| ANDREW R GRETHEL3 | 11739 HICKORY RUN CT LOVELAND, OH 45140 | AFLAC | $5 | — | $5 | 0.01% |
| JAMES J GRETHEL3 | 865 CEDAR DR LOVELAND, OH 45140 | AFLAC | $2 | — | $2 | 0.00% |
| KERSTIN J VANZANTEN3 | 40152 STOWE RD TEMECULA, CA 92591 | AFLAC | $2 | — | $2 | 0.00% |
| DARIN MICHAEL HANDLEY3 | 5017 LIGIA PL EL CAJON, CA 92020 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $1K | $2K | 5.19% |
| BARICH AND ASSOCIATES INSURANCE MAR3 | PO BOX 9355 REDLANDS, CA 92375 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 4.75% |
| LORI LAINE3 | 34676 CONADRIA AVE YUCAIPA, CA 92399 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $914 | $803 | $2K | 3.98% |
| DENISE LUERA3 | 30851 ALTA MIRA DR REDLANDS, CA 92373 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $363 | $857 | $1K | 2.83% |
| LUIS ERNESTO PEREZ3 Filed as: LUIS PEREZ BENEFIT INSURANCE SOLUTI | 861 KENWOOD ST UPLAND, CA 91784 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $925 | $282 | $1K | 2.80% |
| UZIEL RIVERA3 | 1267 SILVER TORCH DR BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $892 | $240 | $1K | 2.63% |
| RONNY ANN WARNER3 | 470 E WHITBECK ST KUNA, ID 83634 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $429 | $223 | $652 | 1.51% |
| RICHARD BLACKSTONE3 | 6374 CHAFFEE ST VENTURA, CA 93003 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $425 | — | $425 | 0.99% |
| CLIENT BENEFIT INSURANCE SERVICES3 Filed as: CLIENT BENEFIT INSURANCE SERVICES I | 10769 WOODSIDE AVE SANTEE, CA 92071 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $347 | — | $347 | 0.80% |
| JOHN D EVANGELISTA3 | 186 LAS FLORES ALISO VIEJO, CA 92656 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $180 | $124 | $304 | 0.71% |
| WILLIAM RYAN KELLY3 | 515 CERRITOS WAY CATHEDRAL CITY, CA 92234 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $119 | $159 | $278 | 0.64% |
| ALLEN MAIRS3 Filed as: ALLEN RAYMOND MAIRS | 780 HIGHWAY 138 CRESTLINE, CA 92325 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $200 | — | $200 | 0.46% |
| RNM SERVICES INC3 | 15833 SARAH RIDGE RD SAN DIEGO, CA 92127 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $60 | $137 | $197 | 0.46% |
| KYLE EDWIN MUSSELMAN3 | 34238 VIA BUENA DR YUCAIPA, CA 92399 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $115 | $56 | $171 | 0.40% |
| DEBORAH RUSH KIMMONS3 | 37291 BOSLEY ST INDIO, CA 92203 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $109 | — | $109 | 0.25% |
| ALKEME INSURANCE SERVICES INC3 | 23151 VERDUGO DR STE 205 LAGUNA HILLS, CA 92653 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $86 | — | $86 | 0.20% |
| EDWIN MANUEL VELASQUEZ3 | 33013 SEVILLE ST LAKE ELSINORE, CA 92530 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $66 | $5 | $71 | 0.16% |
| MICHELLE KAYE LUBICH3 | 12584 14TH ST YUCAIPA, CA 92399 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $68 | — | $68 | 0.16% |
| ANDREA MARIE TIERCE3 | 1199 MADRONE LN PLACERVILLE, CA 95667 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $32 | — | $32 | 0.07% |
| TERIE D BRADFORD3 | 16057 OAKLEY RD RAMONA, CA 92065 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $13 | — | $13 | 0.03% |
No Schedule C service providers reported on this filing.
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 | 179 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 7 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 187 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 325 | $1.7M |
| Dental | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 325 | $1.7M |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 325 | $1.7M |
| Life insurance(3 contracts, 2 carriers) | AFLAC | 55 | $159K |
| Short-term disability(3 contracts, 2 carriers) | AFLAC | 55 | $159K |
| Other(3 contracts, 2 carriers) | AFLAC | 55 | $159K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 325 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.