| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | BLUE CROSS OF CALIFORNIA | $20K | $3K | $23K | 3.15% |
| CENTENNIAL GROUP BENEFITS INSURANCE3 Filed as: CENTENNIAL GROUP BEN. AND INS SVCS. | 1800 QUAIL STREET, SUITE 110 SANTA ANA, CA 92799 | BLUE CROSS OF CALIFORNIA | $20K | $0 | $20K | 2.71% |
| JOHN D EVANGELISTA3 Filed as: JOHN D. EVANGELISTA | 186 LAS FLORES ALISO VIEJO, CA 92656 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $737 | $281 | $1K | 4.57% |
| CENTENIAL GROUP BENEFITS & INS3 Filed as: CENTENIAL GROUP BENEFITS AND INS. | 1800 QUAIL STREET NEWPORT BEACH, CA 92660 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $984 | $0 | $984 | 4.42% |
| GOLD RIVER FINANCIAL GROUP LLC3 Filed as: GOLD RIVER FIN GROUP & OTHER AGENTS | 2807 GRATTON STREET RIVERSIDE, CA 92504 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $174 | $7 | $181 | 0.81% |
| TECH COORDINATOR CYBER INSURANCE SO3 Filed as: TECH COORDINATOR CYBER INSURANCE | 10741 LA JARA STREET CERRITOS, CA 90703 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $180 | $0 | $180 | 0.81% |
| KRISTIN ANN DECOU3 | 751 ROBIN GLEN ROAD BEAUMONT, CA 92223 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $125 | $0 | $125 | 0.56% |
| LUIS ERNESTO PEREZ3 Filed as: LUIS PEREZ BENEFIT INSURANCE SOL. | 861 KENWOOD STREET UPLAND, CA 91784 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $66 | $0 | $66 | 0.30% |
| ANDREA MARIE TIERCE3 | 1199 MADRONE LANE PLACERVILLE, CA 95667 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $27 | $17 | $44 | 0.20% |
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 | 242 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 242 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 104 | $722K |
| Dental | BLUE CROSS OF CALIFORNIA | 104 | $722K |
| Vision | BLUE CROSS OF CALIFORNIA | 104 | $722K |
| Life insurance(2 contracts, 2 carriers) | ANTHEM LIFE INSURANCE COMPANY | 242 | $117K |
| Short-term disability | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 21 | $22K |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 104 | $722K |
| Other(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 242 | $838K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 242 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
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.