| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | BLUE CROSS OF CALIFORNIA | $40K | — | $40K | 3.41% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SERVICES USA INC. | 2030 MAIN ST., SUITE 200 IRVINE, CA 92614 | BLUE CROSS OF CALIFORNIA | $22K | — | $22K | 1.83% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | 8110 E. UNION AVE., SUITE 700 DENVER, CO 80237 | BLUE CROSS OF CALIFORNIA | — | $1K | $1K | 0.13% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | PAN-AMERICAN LIFE INSURANCE COMPANY | $15K | — | $15K | 5.38% |
| WELLS FARGO INSURANCE SERVICES3 | DEPT. 133667 P.O. BOX 39000 SAN FRANCISCO, CA 94139 | PAN-AMERICAN LIFE INSURANCE COMPANY | $12K | — | $12K | 4.22% |
| JOHN D EVANGELISTA3 Filed as: JOHN D. EVANGELISTA | 26111 ANTONIO PARKWAY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16K | $9K | $25K | 18.39% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | 21250 HAWTHORNE BLVD. TORRANCE, CA 90503 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $13K | $1K | $14K | 10.07% |
| SARAH COURTNEY KNAPP3 | 61 SKLAR LADERA RANCH, CA 92694 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6K | $4K | $10K | 7.23% |
| ADRIANA MENDIETA3 | 29448 TOURNS STREET LAKE ELSINORE, CA 92530 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6K | $2K | $8K | 5.96% |
| LUIS ERNESTO PEREZ3 | 861 KENWOOD ST. UPLAND, CA 91784 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6K | $955 | $7K | 4.91% |
| ROLANDO HIRAM DORTA3 | 3011 PISGAH PLACE GREENSBORO, NC 27455 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $113 | $3K | 2.29% |
| JORGE ALEJANDRO MONTEMAYOR3 | 10702 N. 23RD LANE MCALLEN, TX 78504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $479 | $2K | 1.66% |
| GABRIEL HOLGUIN3 | 26342 FOREST BRIDGE DR. LAKE FOREST, CA 92630 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $290 | $2K | 1.41% |
| CAROLINA REGIONAL INSURANCE3 | P.O. BOX 8808 COLUMBIA, SC 29202 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $220 | $1K | 1.07% |
| SOFIA ASHLEY SIMCOX3 | 2250 MARSH LANE SUITE 4111 CARROLLTON, TX 75006 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $178 | $1K | 1.06% |
| ELTHON ISRAEL CRUZ3 | 3800 WEST DEVONSHIRE AVENUE HEMET, CA 92545 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $922 | $74 | $996 | 0.73% |
| MIKE SOLIS QUINTANA3 | 7098 N. GREGORY AVENUE FRESNO, CA 93722 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $863 | $1 | $864 | 0.63% |
| ASCENSION BENEFITS ADVISORS3 | 6 POMEGRANATE ST. LADERA RANCH, CA 92694 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $790 | $1 | $791 | 0.58% |
| CALVIN DEAN INGLE3 | 1840 LARIAT TRAIL CELINA, TX 75009 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $661 | $33 | $694 | 0.51% |
| DOMINGO MUNOZ3 | P.O. BOX 775 CHARLOTTE, TX 78011 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $659 | $19 | $678 | 0.49% |
| LAMBERT MONTALBO3 | 26197 MIRADA ST. HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $575 | $35 | $610 | 0.44% |
| WILLIAM WAYNE STIGILE3 | 514 GRINDSTONE WOODBRIDGE, CA 95258 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $497 | $32 | $529 | 0.39% |
| BILLY WALKER3 | 406 W. LINDEN DR. ORANGE, CA 92865 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $477 | — | $477 | 0.35% |
| DION CHAVEZ3 | 611 E. LOOP 499 HARLINGEN, TX 78550 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $135 | $332 | $467 | 0.34% |
| GRAEM M CLARK3 Filed as: GRAEM M. CLARK | 589 WINDMERE DR. LEXINGTON, SC 29072 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $187 | $252 | $439 | 0.32% |
| MARIA C GONZALEZ3 Filed as: MARIA C. GONZALEZ | 11677 SANDPIPER CT. MORENO VALLEY, CA 92557 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $273 | $37 | $310 | 0.23% |
| SALAZAR INSURANCE GROUP LLC3 | 611 E. LOOP 499 HARLINGEN, TX 78550 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $135 | $156 | $291 | 0.21% |
| SUSAN GOLD STOKES3 Filed as: SUSAN G. STOKES | 3113 W. 187TH PL. TORRANCE, CA 90504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $241 | $41 | $282 | 0.21% |
| TIM JARRELL3 | 301 S. ELM ST. GREENSBORO, NC 27401 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $227 | $50 | $277 | 0.20% |
| ARIADNE DE BASABE-MACHICHE3 | 1102 NIMROD CIRCLE CORONA, CA 92880 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $211 | $59 | $270 | 0.20% |
| DOUGLAS R. KILLIAN3 Filed as: DOUGLAS RICHARD KILLIAN | P.O. BOX 443 STOKESDALE, NC 27357 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $227 | — | $227 | 0.17% |
| BARRY W MAAS3 Filed as: BARRY W. MAAS | P.O. BOX 5809 FRESNO, CA 93755 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $128 | $95 | $223 | 0.16% |
| COLONIAL OF NORTH TEXAS INSURANCE3 | 4621 GLEN HEATHER DRIVE FRISCO, TX 75034 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $106 | $108 | $214 | 0.16% |
| CALIFORNIA INSURANCE ADVOCATES INC3 Filed as: CALIFORNIA INSURANCE ADVOCATES INC. | 41960 AVENIDA DE ANITA TEMECULA, CA 92592 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $138 | $62 | $200 | 0.15% |
| ADVANCED BENEFIT SYSTEM INC3 Filed as: ADVANCED BENEFIT SYSTEM INC. | 1301 GERVAIS STREET COLUMBIA, SC 29201 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $70 | $104 | $174 | 0.13% |
| BARBARA ANN BASTON3 | 5401 MANSEL LANE FORT WORTH, TX 76134 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $125 | $33 | $158 | 0.12% |
| BRIAN WHITE3 Filed as: BRIAN R. MADTES | 1308 JAMES COOK WINDCREST, TX 78239 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $99 | $51 | $150 | 0.11% |
| JAMES R MCCOMB3 Filed as: JAMES R. MCCOMB | 1063 COATESDALE RD. COLUMBIA, SC 29209 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $142 | $4 | $146 | 0.11% |
| SANDRA DRIVER3 | 1703 TAMARACK DRIVE WYLIE, TX 75098 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $96 | $14 | $110 | 0.08% |
| SA GENERAL AGENCY INC3 Filed as: SA GENERAL AGENCY INC. | 9385 MILLER LANE GARDEN RIDGE, TX 78266 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $33 | $67 | $100 | 0.07% |
| MCCAREY INC3 Filed as: MCCAREY INC. | 965 MESA DRIVE CAMARILLO, CA 93010 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $40 | $27 | $67 | 0.05% |
| NICHOLAS ALAN WRIGHT3 | P.O. BOX 851682 MESQUITE, TX 75185 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $63 | — | $63 | 0.05% |
| EDWIN MANUEL VELASQUEZ3 | 33013 SEVILLE STREET LAKE ELSINORE, CA 92530 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $53 | $9 | $62 | 0.05% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $32 | $1 | $33 | 0.02% |
| ANDREA MARIE TIERCE3 | 2204 PLEASANTWOOD LANE ESCONDIDO, CA 92026 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $14 | $9 | $23 | 0.02% |
| JACK ALLEN NORRIS3 | 1204 LEXINGTON STREET, SUITE 2B IRMO, SC 29063 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $11 | — | $11 | 0.01% |
| STEPHANIE A LEVINS3 Filed as: STEPHANIE A. LEVINS | 3941 HERITAGE VIEW TRAIL WAKE FOREST, NC 27587 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $11 | — | $11 | 0.01% |
| JOE FERNANDEZ3 | 6136 FRISCO SQUARE BLVD. FRISCO, TX 75034 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | $1 | $9 | 0.01% |
| CAPSTONE BENEFIT SOLUTIONS LLC3 | 901 LAKESIDE CIRCLE LEWISVILLE, TX 75057 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | — | $8 | 0.01% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD., SUITE 100 PASADENA, CA 91107 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $3K | — | $3K | 7.55% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | INC. 2030 MAIN ST., SUITE 200 IRVINE, CA 92614 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $1K | — | $1K | 2.45% |
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 | 383 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 384 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 285 | $1.5M |
| Dental(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 160 | $1.2M |
| Vision | BLUE CROSS OF CALIFORNIA | 160 | $1.2M |
| Life insurance(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 210 | $1.3M |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 210 | $137K |
| Long-term disability | BLUE CROSS OF CALIFORNIA | 160 | $1.2M |
| Other(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 210 | $1.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 285 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.