| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EMPLOYER RESOURCE GROUP & INSURANCE3 | PO BOX 5010 LA QUINTA, CA 92248 | HEALTH NET | $34K | — | $34K | 2.24% |
| EDWARD J THURIN3 | 17800 BRAZIER RD RIVERSIDE, CA 92508 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 3.95% |
| JOHN HENRY GARCIA3 | 48794 PEAR ST INDIO, CA 92201 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $625 | — | $625 | 2.35% |
| EDWIN MANUEL VELASQUEZ3 | 33013 SEVILLE ST LAKE ELSINORE, CA 92530 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $437 | $65 | $502 | 1.89% |
| DEBORAH RUSH KIMMONS3 | 37291 BOSLEY ST INDIO, CA 92203 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $485 | $16 | $501 | 1.89% |
| WANDA MCGINTY3 | 29075 RED TAIL CT HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $198 | — | $198 | 0.75% |
| LORI LAINE3 | 35837 CARTER ST YUCAIPA, CA 92399 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $175 | $20 | $195 | 0.73% |
| MARIA C GONZALEZ3 | 11677 SANDPIPER CT MORENO VALLEY, CA 92557 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $108 | $8 | $116 | 0.44% |
| GCG FINANCIAL LLC3 Filed as: TERRANCE HUGH DICKERSON | 34400 GLENWOOD DR YUCAIPA, CA 92399 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $91 | $22 | $113 | 0.43% |
| KATHLEEN SPILLMAN-OREL3 | 1499 OLD MOUNTAIN RD SAN JACINTO, CA 92583 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $69 | — | $69 | 0.26% |
| MIKE MCCORMICK3 | 348 S STRONGS CT SALT LAKE CITY, UT 84102 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $48 | — | $48 | 0.18% |
| ELTHON ISRAEL CRUZ3 | 3800 WEST DEVONSHIRE AVE HEMET, CA 92545 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $43 | — | $43 | 0.16% |
| MARTHA R BAEZ3 | 2179 OLD BRIDGE RD RIVERSIDE, CA 92506 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $37 | — | $37 | 0.14% |
| PATRICIA DANIELS3 | 34772 ELMWOOD LN YUCAIPA, CA 92399 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $31 | — | $31 | 0.12% |
| MICHAEL C WALKER3 Filed as: MICHAEL J MINNEY | PO BOX 365 POWAY, CA 92074 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $18 | — | $18 | 0.07% |
| BOELZNER AND ASSOC INS SVCS3 | PO BOX 269 PALM DESERT, CA 92261 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | — | $12 | 0.05% |
| PEBBLE ANTONETTE ARNICK3 | 20 PALATINE, APT 308 IRVINE, CA 92612 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $11 | — | $11 | 0.04% |
| JACK F KIMMONS3 | 37291 BOSLEY ST INDIO, CA 92203 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | — | $6 | 0.02% |
| HOLLERN & ASSOCIATES INCORPORATED3 Filed as: HOLLERN & ASSOCIATES | 11412 ROBBIA DR LAS VEGAS, NV 89138 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.01% |
| EMPLOYER RESOURCE GROUP & INSURANCE3 Filed as: EMPLOYER RESOURCE GROUP & INS | 47-110 WASHINGTON ST, SUITE 202 LA QUINTA, CA 92253 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 15.00% |
| PACIFIC ADVISORS LLC3 Filed as: PACIFIC ADVISORS INC | 333 N INDIAN HILL BLVD CLAREMONT, CA 91711 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $38 | — | $38 | 0.17% |
| JOHN HENRY GARCIA3 | 48794 PEAR ST INDIO, CA 92201 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $26 | — | $26 | 1.70% |
| EDWARD J THURIN3 | 17800 BRAZIER RD RIVERSIDE, CA 92508 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $24 | — | $24 | 1.57% |
| MARIA C GONZALEZ3 | 11677 SANDPIPER CT MORENO VALLEY, CA 92557 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | — | $8 | 0.52% |
| DEBORAH RUSH KIMMONS3 | 37291 BOSLEY ST INDIO, CA 92203 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | — | $8 | 0.52% |
| PATRICIA DANIELS3 | 34772 ELMWOOD LN YUCAIPA, CA 92399 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | — | $6 | 0.39% |
| MIKE MCCORMICK3 | 348 S STRONGS CT SALT LAKE CITY, UT 84102 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.20% |
| LORI LAINE3 | 35837 CARTER ST YUCAIPA, CA 92399 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.13% |
| GCG FINANCIAL LLC3 Filed as: TERRANCE HUGH DICKERSON | 34400 GLENWOOD DR YUCAIPA, CA 92399 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.07% |
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 | 282 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 283 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTH NET | 259 | $1.5M |
| Dental | HEALTH NET | 259 | $1.5M |
| Vision | HEALTH NET | 259 | $1.5M |
| Life insurance(3 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 282 | $51K |
| Short-term disability(2 contracts) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 22 | $28K |
| Other(3 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 282 | $51K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 282 | — |
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."
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.