| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DMJ INSURANCE SERVICES INC.3 Filed as: DMJ INSURANCE SERVICES INC | 333 N LANTANA 295 CAMARILLO, CA 93010 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $111K | — | $111K | 5.05% |
| DMJ INSURANCE SERVICES INC.3 Filed as: DMJ INSURANCE SERVICES INC | 333 N LANTANA 295 CAMARILLO, CA 93010 | UNITEDHEALTHCARE INSURANCE COMPANY | $15K | — | $15K | 15.00% |
| DMJ INSURANCE SERVICES INC.3 Filed as: DMJ INSURANCE SERVICES INC | 333 N LANTANA STREET CAMARILLO, CA 93010 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 14.31% |
| KRISTIN LEASE3 | 3890 HOWARD AVE LOS ALAMITOS, CA 90720 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $70 | $132 | $202 | 2.42% |
| MCCAREY INC3 | 6320 GREENHAVEN DR CARLSBAD, CA 92009 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $83 | $1 | $84 | 1.01% |
| DANA MARIE MOWATT3 | 23701 S WESTERN AVE SPC 112 TORRANCE, CA 90501 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $25 | $10 | $35 | 0.42% |
| RONNY ANN WARNER3 | 470 E WHITBECK ST KUNA, ID 83634 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $20 | $1 | $21 | 0.25% |
| ANDREA MARIE TIERCE3 | 1199 MADRONE LN PLACERVILLE, CA 95667 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $20 | $1 | $21 | 0.25% |
| UZIEL RIVERA3 | 1267 SILVER TORCH DR BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | $1 | $5 | 0.06% |
| MCCAREY INC3 | 6320 GREENHAVEN DR CARLBAD, CA 92009 | THE PAUL REVERE LIFE INSURANCE COMPANY | $6 | — | $6 | 0.98% |
| RONNY ANN WARNER3 | 470 E WHITBECK ST KUNA, ID 83634 | THE PAUL REVERE LIFE INSURANCE COMPANY | $2 | — | $2 | 0.33% |
| ANDREA MARIE TIERCE3 | 1199 MADRONE LN PLACERVILLE, CA 95667 | THE PAUL REVERE LIFE INSURANCE COMPANY | $2 | — | $2 | 0.33% |
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 | 122 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 122 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 182 | $2.2M |
| Dental | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 182 | $2.2M |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 182 | $2.2M |
| Life insurance(3 contracts, 3 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 115 | $108K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 30 | $8K |
| Long-term disability | UNITEDHEALTHCARE INSURANCE COMPANY | 115 | $99K |
| Other | UNITEDHEALTHCARE INSURANCE COMPANY | 115 | $99K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 182 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.