| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LIBERTY COMPANY INSURANCE BROKERS3 | 5955 DE SOTO AVENUE, SUITE 250 WOODLAND HILLS, CA 91367 | BLUE CROSS OF CALIFORNIA | $97K | $0 | $97K | 5.07% |
| HAYS COMPANIES, INC.3 | 80 SOUTH 8TH STREET MINNEAPOLIS, MN 55402 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $769 | $5K | 2.89% |
| JOHN D EVANGELISTA3 Filed as: JOHN D. EVANGELISTA | 186 LAS FLORES ALISO VIEJO, CA 92656 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $929 | $5K | 2.68% |
| GOLD RIVER FINANCIAL GROUP LLC3 Filed as: GOLD RIVER FIN. GRP. & OTHER AGENTS | 2807 GRATTON STREET RIVERSIDE, CA 92504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $263 | $4K | 2.32% |
| SARAH COURTNEY KNAPP3 | 61 SKYLAR STREET LADERA RANCH, CA 92694 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $358 | $2K | 1.14% |
| TECH COORDINATOR CYBER INSURANCE SO3 | 10741 LA JARA STREET CERRITOS, CA 90703 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $31 | $2K | 1.08% |
| USI INSURANCE SERVICES LLC3 | 21250 HAWTHORNE BOULEVARD TORRANCE, CA 90503 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $0 | $1K | 0.71% |
| LIBERTY COMPANY INSURANCE BROKERS3 | 5955 DE SOTO AVENUE, SUITE 250 WOODLAND HILLS, CA 91367 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $0 | $1K | 0.61% |
| LIBERTY COMPANY INSURANCE BROKERS3 | 5955 DE SOTO AVENUE, SUITE 250 WOODLAND HILLS, CA 91367 | STANDARD INSURANCE COMPANY | $831 | $145 | $976 | 11.83% |
| LIBERTY COMPANY INSURANCE BROKERS3 | 5955 DE SOTO AVENUE, SUITE 250 WOODLAND HILLS, CA 91367 | ANTHEM LIFE INSURANCE COMPANY | $202 | $0 | $202 | 6.77% |
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 | 247 | 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) | 247 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 291 | $1.9M |
| Dental | BLUE CROSS OF CALIFORNIA | 291 | $1.9M |
| Vision | BLUE CROSS OF CALIFORNIA | 291 | $1.9M |
| Life insurance(3 contracts, 3 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 267 | $193K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 124 | $182K |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 291 | $1.9M |
| Other(4 contracts, 4 carriers) | BLUE CROSS OF CALIFORNIA | 291 | $2.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 291 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.