| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FOUNDATION RISK PARTNERS CORP3 Filed as: FOUNDATION RISK PARTNERS, CORP. LLC | 1540 CORNERSTONE BOULEVARD DAYTONA BEACH, FL 32117 | AETNA HEALTH OF CALIFORNIA, INC. | $39K | $0 | $39K | 4.81% |
| FOUNDATION RISK PARTNERS CORP3 Filed as: FOUNDATION RISK PARTNERS, LLC | 1540 CORNERSTONE BOULEVARD DAYTONA BEACH, FL 32117 | AETNA LIFE INSURANCE COMPANY | $24K | $0 | $24K | 4.94% |
| FOUNDATION RISK PARTNERS CORP3 Filed as: FOUNDATION RISK PARTNERS, CORP. | 2125 YGNACIO VALLEY ROAD, SUITE 200 WALNUT CREEK, CA 94598 | KAISER FOUNDATION HEALTH PLAN, INC. | $4K | $0 | $4K | 4.27% |
| RSC INSURANCE BROKERAGE INC3 Filed as: RSC INSURANCE BROKERAGE, INC. | 2270 DOUGLAS BOULEVARD, SUITE 220 ROSEVILLE, CA 95661 | KAISER FOUNDATION HEALTH PLAN, INC. | $501 | $0 | $501 | 0.48% |
| RAMONA MARGARET DALY3 | 2877 CALLE HERALDO SAN CLEMENTE, CA 92673 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $15K | $2K | $17K | 19.99% |
| CONSUMER DRIVEN BENEFITS LLC3 Filed as: CONSUMER DRIVEN BENEFITS, LLC | 1772 SUNSET VIEW DRIVE TRABUCO CANYON, CA 92679 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $737 | $927 | $2K | 2.00% |
| VALOR BENEFITS3 | 12125 KOUDEKERK STREET ARTESIA, CA 90701 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $734 | $123 | $857 | 1.03% |
| CENTENIAL GROUP BENEFITS & INS3 Filed as: CENTENIAL GROUP BENEFITS & INSURA. | 1800 QUAIL STREET NEWPORT BEACH, CA 92660 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $470 | $0 | $470 | 0.56% |
| JOHN D EVANGELISTA3 Filed as: JOHN D. EVANGELISTA & OTHER AGENTS | 186 LAS FLORES ALISO VIEJO, CA 92679 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $371 | $8 | $379 | 0.46% |
| CONCEIRGE BENEFITS & INS. SERVICES3 | 3535 LINDA VISTA DRIVE SAN MARCOS, CA 92078 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $133 | $0 | $133 | 0.16% |
| JB CREATIVE SOLUTIONS LLC3 Filed as: JB CREATIVE SOLUTIONS, LLC | 3881 FREEMAN WAY PROSPER, TX 75078 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $111 | $2 | $113 | 0.14% |
| FOUNDATION RISK PARTNERS CORP3 Filed as: FOUNDATION RISK CORP. DBA PINNACLE | 2125 YGNACIO VALLEY ROAD, SUITE 200 WALNUT CREEK, CA 94598 | HUMANA INSURANCE COMPANY | $5K | $0 | $5K | 8.96% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SVC, INC. | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | HUMANA INSURANCE COMPANY | $189 | $329 | $518 | 0.87% |
| RSC INSURANCE BROKERAGE INC3 Filed as: RSC INSURANCE BROKERAGE, INC. | 9350 SOUTH DIXIE HIGHWAY, SUITE 140 MIAMI, FL 33156 | HUMANA INSURANCE COMPANY | $512 | $0 | $512 | 0.86% |
| FOUNDATION RISK PARTNERS CORP3 Filed as: FOUNDATION RISK CORP. DBA PINNACLE | 2125 YGNACIO VALLEY ROAD, SUITE 200 WALNUT CREEK, CA 94598 | HUMANADENTAL INSURANCE COMPANY | $704 | $0 | $704 | 9.09% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SVC, INC. | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | HUMANADENTAL INSURANCE COMPANY | $26 | $138 | $164 | 2.12% |
| RSC INSURANCE BROKERAGE INC3 Filed as: RSC INSURANCE BROKERAGE, INC. | 9350 SOUTH DIXIE HIGHWAY, SUITE 140 MIAMI, FL 33156 | HUMANADENTAL INSURANCE COMPANY | $68 | $0 | $68 | 0.88% |
| RSC INSURANCE BROKERAGE INC3 Filed as: RSC INSURANCE BROKERAGE, INC. | 2040 MAIN STREET, SUITE 450 IRVINE, CA 92614 | UNUM LIFE INSURANCE COMPANY OF AMERICA | -$31 | $0 | -$31 | -2.23% |
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 | 202 | 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) | 203 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | AETNA HEALTH OF CALIFORNIA, INC. | 108 | $1.4M |
| Dental(2 contracts, 2 carriers) | HUMANA INSURANCE COMPANY | 117 | $67K |
| Vision | HUMANA INSURANCE COMPANY | 117 | $60K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 202 | $10K |
| Short-term disability | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 52 | $83K |
| Long-term disability | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 52 | $83K |
| Prescription drug(3 contracts, 3 carriers) | AETNA HEALTH OF CALIFORNIA, INC. | 108 | $1.4M |
| Other(3 contracts, 3 carriers) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 202 | $94K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 202 | — |
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.