| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MOORE BENEFITS INC.3 | 30 CORPORATE PARK, SUITE 106 IRVINE, CA 92606 | BLUE CROSS OF CALIFORNIA | $91K | — | $91K | 4.32% |
| MOORE BENEFITS INC.3 | 30 CORPORATE PARK, SUITE 106 IRVINE, CA 92606 | PRINCIPAL LIFE INSURANCE COMPANY | $14K | $5K | $19K | 7.94% |
| RAMONA MARGARET DALY3 | 402 CAMINO BANDERA SAN CLEMENTE, CA 92673 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $190 | $2K | 9.11% |
| MOORE BENEFITS INC.3 | 30 CORPORATE PARK, SUITE 106 IRVINE, CA 92606 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 7.97% |
| CYNTHIA MARINA INGLE3 Filed as: CYNTHIA INGLE | 1834 KNAPP DRIVE VISTA, CA 92084 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $488 | $30 | $518 | 2.09% |
| CONSUMER DRIVEN BENEFITS LLC3 | 3737 BIRCH STREET NEWPORT BEACH, CA 92660 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $285 | $195 | $480 | 1.94% |
| SHANIKA M. FISKE3 Filed as: SHANIKA M FISKE | 15 TUOLUMNE WAY ALISO VIEJO, CA 92656 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $110 | $38 | $148 | 0.60% |
| RONDA LEE SUTO3 | 2211 N. POINSETTIA STREET SANTA ANA, CA 92706 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $67 | $10 | $77 | 0.31% |
| JOSEPH RUBINO3 | 1806 BRABHAM STREET EL CAJON, CA 92019 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $37 | — | $37 | 0.15% |
| RACHEL DARLENE DUBE3 | 1 PEBBLEWOOD IRVINE, CA 92604 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $30 | $5 | $35 | 0.14% |
| TINA HERNANDEZ3 | 11258 WEST LINCOLN STREET AVONDALE, AZ 85323 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $27 | $3 | $30 | 0.12% |
| MARIANNA REBECCA WEAVER3 | 20092 CHAMPLAIN LAKE FOREST, CA 92630 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $24 | — | $24 | 0.10% |
| MICHAEL F FAHEY III3 | 411 AVENIDA ADOBE SAN CLEMENTE, CA 92672 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $20 | — | $20 | 0.08% |
| MARGARITA ALEJANDRA RAMIREZ3 | 1356 CALLE COLNETT SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.01% |
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 | 143 | 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) | 144 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 307 | $2.1M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 324 | $233K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 312 | $71K |
| Life insurance(3 contracts, 3 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 324 | $329K |
| Short-term disability(2 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 312 | $96K |
| Long-term disability(2 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 312 | $96K |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 307 | $2.1M |
| Other(2 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 312 | $96K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 324 | — |
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.