| 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 | $64K | — | $64K | 4.73% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | PAN-AMERICAN LIFE INSURANCE COMPANY | $29K | — | $29K | 10.00% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | 21250 HAWTHORNE BLVD. TORRANCE, CA 90503 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8K | — | $8K | 8.13% |
| JOHN D EVANGELISTA3 Filed as: JOHN D. EVANGELISTA | 26111 ANTONIO PARKWAY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $953 | $5K | 5.08% |
| ADRIANA MENDIETA3 | 29448 TOURS STREET LAKE ELSINORE, CA 92530 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $414 | $2K | 2.05% |
| SARAH COURTNEY KNAPP3 | 61 SKLAR LADERA RANCH, CA 92694 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $264 | $2K | 1.76% |
| LUIS ERNESTO PEREZ3 | 861 KENWOOD ST. UPLAND, CA 91784 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $138 | $1K | 1.31% |
| ROLANDO HIRAM DORTA3 | 3011 PISGAH PLACE GREENSBORO, NC 27455 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $800 | — | $800 | 0.79% |
| GABRIEL HOLGUIN3 | 2807 GRATTON ST. RIVERSIDE, CA 92504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $362 | $59 | $421 | 0.41% |
| JORGE ALEJANDRO MONTEMAYOR3 | 10702 N. 23RD LANE MCALLEN, TX 78504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $355 | $37 | $392 | 0.39% |
| CAROLINA REGIONAL INSURANCE3 | P.O. BOX 8808 COLUMBIA, SC 29202 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $275 | $23 | $298 | 0.29% |
| SOFIA ASHLEY SIMCOX3 | 2250 MARSH LANE, SUITE 4111 CARROLLTON, TX 78266 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $243 | $14 | $257 | 0.25% |
| ASCENSION BENEFITS ADVISORS3 | 6 POMEGRANATE ST. LADERA RANCH, CA 92694 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $216 | — | $216 | 0.21% |
| LIFE TIME SOLUTIONS LLC3 | 861 KENWOOD ST. UPLAND, CA 91784 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $204 | — | $204 | 0.20% |
| CALVIN DEAN INGLE3 | 1840 LARIAT TRAIL CELINA, TX 75009 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $191 | $13 | $204 | 0.20% |
| ELTHON ISRAEL CRUZ3 | 3800 WEST DEVONSHIRE AVE. HEMET, CA 92545 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $162 | $27 | $189 | 0.19% |
| MIKE SOLIS QUINTANA3 | 7098 N. GREGORY AVENUE FRESNO, CA 93722 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $175 | — | $175 | 0.17% |
| LAMBERT MONTALBO3 | 26197 MIRADA ST. HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $144 | $14 | $158 | 0.16% |
| WILLIAM WAYNE STIGILE3 | 514 GRINDSTONE WOODBRIDGE, CA 95258 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $146 | $1 | $147 | 0.14% |
| BILLY WALKER3 | 406 ORANGE, CA 92865 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $92 | — | $92 | 0.09% |
| GRAEM M CLARK3 Filed as: GRAEM M. CLARK | 589 WINDMERE DRIVE LEXINGTON, SC 29072 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $35 | $50 | $85 | 0.08% |
| DOMINGO MUNOZ3 | P.O. BOX 775 CHARLOTTE, TX 78011 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $70 | $2 | $72 | 0.07% |
| SUSAN GOLD STOKES3 Filed as: SUSAN G. STOKES | 3113 W. 187TH PL. TORRANCE, CA 90504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $71 | — | $71 | 0.07% |
| DOUGLAS R. KILLIAN3 Filed as: DOUGLAS RICHARD KILLIAN | P.O. BOX 443 STOKESDALE, NC 27357 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $60 | — | $60 | 0.06% |
| TIM JARRELL3 | 301 S. ELM ST. GREENSBORO, NC 27401 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $60 | — | $60 | 0.06% |
| JAMES R MCCOMB3 Filed as: JAMES R. MCCOMB | 1063 COATESDALE RD. COLUMBIA, SC 29209 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $58 | — | $58 | 0.06% |
| MCCAREY INC3 Filed as: MCCAREY INC. | 965 MESA DRIVE CAMARILLO, CA 93010 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $22 | $35 | $57 | 0.06% |
| SALAZAR INSURANCE GROUP LLC3 | 611 E. LOOP 499 HARLINGEN, TX 78550 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $25 | $24 | $49 | 0.05% |
| DION CHAVEZ3 | 611 E. LOOP 499 HARLINGEN, TX 78550 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $25 | $17 | $42 | 0.04% |
| EDWIN MANUEL VELASQUEZ3 | 33013 SEVILLE STREET LAKE ELSINORE, CA 92530 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $31 | $7 | $38 | 0.04% |
| COLONIAL OF NORTH TEXAS INSURANCE3 | 4621 GLEN HEATHER DRIVE FRISCO, TX 75034 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $17 | $21 | $38 | 0.04% |
| ARIADNE DE BASABE-MACHICHE3 | 1102 NIMROD CIRCLE CORONA, CA 92880 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $33 | $1 | $34 | 0.03% |
| MARIA C GONZALEZ3 Filed as: MARIA C. GONZALEZ | 11677 SANDPIPER CT. MORENO VALLEY, CA 92557 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $32 | — | $32 | 0.03% |
| BARRY W MAAS3 Filed as: BARRY W. MAAS | P.O. BOX 5809 FRESNO, CA 93755 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $26 | $6 | $32 | 0.03% |
| BARBARA ANN BASTON3 | 5401 MANSEL LANE FT. WORTH, TX 76134 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $31 | — | $31 | 0.03% |
| ADVANCED BENEFIT SYSTEM INC3 Filed as: ADVANCED BENEFIT SYSTEM INC. | 1301 GERVAIS STREET COLUMBIA, SC 29201 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | $18 | $30 | 0.03% |
| CALIFORNIA INSURANCE ADVOCATES INC3 Filed as: CALIFORNIA INSURANCE ADVOCATES INC. | 41960 AVENIDA DE ANITA TEMECULA, CA 92592 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $19 | $8 | $27 | 0.03% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY INSURANCE BROKERS | P.O. BOX 6030 PASADENA, CA 91102 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $18 | — | $18 | 0.02% |
| SANDRA DRIVER3 | 1703 TAMARACK DRIVE WYLIE, TX 75098 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16 | — | $16 | 0.02% |
| BRIAN WHITE3 Filed as: BRIAN R. MADTES | 1308 JAMES COOK WINDCREST, TX 78239 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | $5 | $15 | 0.01% |
| ANDREA MARIE TIERCE3 | 2204 PLEASANTWOOD LANE ESCONDIDO, CA 92026 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | $5 | $13 | 0.01% |
| NICHOLAS ALAN WRIGHT3 | P.O. BOX 851682 MESQUITE, TX 75185 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | — | $10 | 0.01% |
| SA GENERAL AGENCY INC3 Filed as: SA GENERAL AGENCY INC. | 9385 MILLER LANE GARDEN RIDGE, TX 78266 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | $3 | $6 | 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 | 125 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 125 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 300 | $1.6M |
| Dental | BLUE CROSS OF CALIFORNIA | 160 | $1.4M |
| Vision | BLUE CROSS OF CALIFORNIA | 160 | $1.4M |
| Life insurance(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 160 | $1.5M |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 105 | $102K |
| Long-term disability | BLUE CROSS OF CALIFORNIA | 160 | $1.4M |
| Other(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 160 | $1.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 300 | — |
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.