| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MOORE BENEFITS INC.3 | 18662 MACARTHUR BLVD., SUITE 480 IRVINE, CA 92612 | BLUE CROSS OF CALIFORNIA | $70K | — | $70K | 3.96% |
| MOORE BENEFITS INC.3 | 18662 MACARTHUR BLVD., SUITE 480 IRVINE, CA 926121230 | PRINCIPAL LIFE INSURANCE COMPANY | $6K | — | $6K | 3.88% |
| MOORE BENEFITS INC.3 | 18662 MACARTHUR BLVD., SUITE 480 IRVINE, CA 92612 | PRINCIPAL LIFE INSURANCE COMPANY | $9K | — | $9K | 13.83% |
| MOORE BENEFITS INC.3 | 18662 MACARTHUR BLVD., SUITE 480 IRVINE, CA 92612 | VISION SERVICE PLAN / HEALTHSMART BENEFIT SOLUTIONS, INC. | $3K | $180 | $3K | 8.37% |
| RAMONA MARGARET DALY3 | 402 CAMINO BANDERA SAN CLEMENTE, CA 92673 | COLONIAL LIFE ACCIDENT INSURANCE COMPANY | $1K | $105 | $1K | 8.89% |
| MOORE BENEFITS INC.3 | 18662 MACARTHUR BLVD., SUITE 480 IRVINE, CA 92612 | COLONIAL LIFE ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 6.84% |
| CONSUMER DRIVEN BENEFITS LLC3 | 3737 BIRCH STREET NEWPORT BEACH, CA 92660 | COLONIAL LIFE ACCIDENT INSURANCE COMPANY | $152 | $173 | $325 | 2.03% |
| MARIANNA REBECCA WEAVER3 | 1301 DOVE STREET NEWPORT BEACH, CA 92660 | COLONIAL LIFE ACCIDENT INSURANCE COMPANY | $74 | $2 | $76 | 0.47% |
| TINA HERNANDEZ3 | 6442 ROSTRATA STREET BUENA PARK, CA 90621 | COLONIAL LIFE ACCIDENT INSURANCE COMPANY | $29 | $37 | $66 | 0.41% |
| SHANIKA M. FISKE3 Filed as: SHANIKA M FISKE | 16 TUOLUMNE WAY ALISO VIEJO, CA 92656 | COLONIAL LIFE ACCIDENT INSURANCE COMPANY | $40 | $19 | $59 | 0.37% |
| JOSEPH RUBINO3 | 1806 BRABHAM STREET EL CAJON, CA 92019 | COLONIAL LIFE ACCIDENT INSURANCE COMPANY | $48 | — | $48 | 0.30% |
| RONDA LEE SUTO3 | 2213 MELODY LANE FULLERTON, CA 92831 | COLONIAL LIFE ACCIDENT INSURANCE COMPANY | $34 | — | $34 | 0.21% |
| MICHAEL F FAHEY III3 | 411 AVENIDA ADOBE SAN CLEMENTE, CA 92672 | COLONIAL LIFE ACCIDENT INSURANCE COMPANY | $32 | — | $32 | 0.20% |
| RACHAEL DARLENE DUBE3 Filed as: RACHAEL DARLEN DUBE | 1013 OAK GLEN IRVINE, CA 92618 | COLONIAL LIFE ACCIDENT INSURANCE COMPANY | $15 | — | $15 | 0.09% |
| MARGARITA ALEJANDRA RAMIREZ3 | 1356 CALLE COLNETT SAN MARCOS, CA 92069 | COLONIAL LIFE ACCIDENT INSURANCE COMPANY | $14 | — | $14 | 0.09% |
| MOORE BENEFITS INC.3 | 18662 MACARTHUR BLVD., SUITE 480 IRVINE, CA 92612 | CALIFORNIA DENTAL NETWORK, INC. | $102 | — | $102 | 9.99% |
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 | 117 | 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) | 117 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 280 | $1.8M |
| Dental(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 270 | $149K |
| Vision | VISION SERVICE PLAN / HEALTHSMART BENEFIT SOLUTIONS, INC. | 104 | $33K |
| Life insurance(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 178 | $80K |
| Short-term disability(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 178 | $80K |
| Long-term disability(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 178 | $80K |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 280 | $1.8M |
| Other | COLONIAL LIFE ACCIDENT INSURANCE COMPANY | 21 | $16K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 280 | — |
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.