| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BURNHAM BENEFITS INSURANCE SERVICES3 Filed as: BURNHAM BENEFITS INS. SVCS. | 2211 MICHELSON DRIVE SUITE 1200 IRVINE, CA 92612 | KAISER FOUNDATION HEALTH PLAN INC | $10K | $40 | $10K | 1.12% |
| THOMAS MARTIN LEVINSTEIN3 Filed as: THOMAS LEVINSTEIN AND OTHERS | 16 PHEASANT LANE ALISO VIEJO, CA 92656 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $12K | $2K | $14K | 11.33% |
| CALIFORNIA INSURANCE ADVOCATES INC3 Filed as: CALIFORNIA INS. ADVOC. INC. | 41960 AVENIDA DE ANITA TEMECULA, CA 92592 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $7K | $2K | $10K | 7.64% |
| BEACON PATH, INC.3 Filed as: BEACON PATH INC. | 26522 LA ALAMEDA MISSION VIEJO, CA 92691 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $7K | $0 | $7K | 5.68% |
| TIMOTHY M. JONES3 | 17075 SAN BRUNO STREET UNIT E FOUNTAIN VALLEY, CA 92708 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $2K | $4K | 2.94% |
| ANDREA MARIE TIERCE3 | 2204 PLEASANTWOOD LANE ESCONDIDO, CA 92026 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $977 | $3K | 2.31% |
| R & B ENROLLMENT SERVICES INC3 Filed as: R AND B ENROLLMENT SVCS. INC. | PO BOX 3216 CRESTLINE, CA 92325 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $203 | $2K | 1.63% |
| LESLIE GRAY3 Filed as: LESLIE DOREEN GRAY | 5 UPPER NEWPORT PLAZA NEWPORT BEACH, CA 92660 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $0 | $2K | 1.62% |
| LESLIE D GRAY3 Filed as: LESLIE D. GRAY | 8583 IRVINE CENTER DRIVE SUITE 155 IRVINE, CA 92618 | BLUE CROSS OF CALIFORNIA | $5K | $0 | $5K | 6.18% |
| BURNHAM BENEFITS INSURANCE SERVICES3 Filed as: BURNHAM BENEFITS INS. SVCS. | 2211 MICHELSON DRIVE SUITE 1200 IRVINE, CA 92612 | BLUE CROSS OF CALIFORNIA | $763 | $0 | $763 | 0.99% |
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 | 163 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 9 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 172 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 277 | $883K |
| Dental | BLUE CROSS OF CALIFORNIA | 164 | $77K |
| Vision | BLUE CROSS OF CALIFORNIA | 164 | $77K |
| Life insurance(2 contracts, 2 carriers) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 164 | $202K |
| Short-term disability | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 110 | $125K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 277 | $883K |
| Other(2 contracts, 2 carriers) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 164 | $202K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 277 | — |
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.