| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PETRA PACIFIC INS SERVICE, INC3 Filed as: PETRA PACIFIC INSURANCE SERVICES | INC. 13950 CERRITOS CORPORATE DR. CERRITOS, CA 90703 | BLUE CROSS OF CALIFORNIA | $33K | — | $33K | 4.62% |
| PETRA PACIFIC INS SERVICE, INC3 Filed as: PETRA PACIFIC INSURANCE SERVICES | 13950 CERRITOS CORPORATE CERRITOS, CA 90703 | GUARDIAN | $7K | — | $7K | 10.00% |
| AUTHORIZED BENEFIT PLANS INS3 Filed as: AUTHORIZED BENEFIT PLANS INC | 430 W WARNER RD TEMPE, AZ 85284 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 11.73% |
| SUSAN HENDRICKS3 | 6718 N PALM CANYON DR PHOENIX, AZ 85018 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $783 | $42 | $825 | 4.03% |
| KATHRYN LOUISE BALDWIN3 | 3310 E. WISTERIA PLACE CHANDLER, AZ 85286 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $744 | — | $744 | 3.64% |
| TAMARA ANNE HINES3 Filed as: TAMARA ANNE WATSON | 8200 OFFENHAUSER DR RENO, NV 89511 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $232 | $25 | $257 | 1.26% |
| LAMBERT MONTALBO3 | 26197 MIRADA ST HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $224 | $32 | $256 | 1.25% |
| GLORIA GUERRA3 | 34212 N 23RD GLEN PHOENIX, AZ 85085 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $173 | $19 | $192 | 0.94% |
| DEBORAH LYNN WELLS3 | 5809 MARK TWAIN AVENUE SACRAMENTO, CA 95820 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $140 | $21 | $161 | 0.79% |
| MARIA VERONICA JARQUE3 | 4085 NOBEL DR. #29 SAN DIEGO, CA 92122 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $101 | $19 | $120 | 0.59% |
| BRIAN R HESCH3 Filed as: BRIAN REUBEN HESCH | 7820 ENCHANTED HILLS BLVD RIO RANCHO, NM 87144 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $116 | — | $116 | 0.57% |
| MARIA RUBY QUINTANA3 | 18214 VIA CALMA ROWLAND HEIGHTS, CA 91748 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $68 | $42 | $110 | 0.54% |
| GENTRY INSURANCE INC3 Filed as: GENTRY INSURANCE INC. | 9140 W COOLBROOK AVE PEORIA, AZ 85382 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $77 | — | $77 | 0.38% |
| ZULMA YESENIA MAZARIEGOS3 | 302 E CHESTNUT AVE SANTA ANA, CA 92701 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $69 | — | $69 | 0.34% |
| PROSESSION INC3 Filed as: PROSESSION INC. | 950 UNIVERSITY PARK LOOP N RENO, NV 89512 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $18 | $38 | $56 | 0.27% |
| JAROLD L WELKER3 | 1922 N 45TH ST PHOENIX, AZ 85008 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $48 | $2 | $50 | 0.24% |
| DONNA ROSS SMITH3 Filed as: DONNA MARIE WARREN | 4142 N 25TH ST APT 23 PHOENIX, AZ 85016 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $46 | $2 | $48 | 0.23% |
| JAMES D THRESHER3 | 1316 E NIGHTINGALE LANE GILBERT, AZ 85298 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $17 | $26 | $43 | 0.21% |
| DARRYL W VIDOR3 | 104 PIONEER DR FOLSOM, CA 95630 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $15 | $14 | $29 | 0.14% |
| MARDEIO CANNON3 | 5027 DYNASTY WAY SACRAMENTO, CA 95835 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $26 | $1 | $27 | 0.13% |
| MARLENE RAMIREZ3 | 12316 QUARTZ DR VICTORVILLE, CA 92392 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $24 | — | $24 | 0.12% |
| GREG KARCHIKIAN3 | 4533 CALEDONIA WAY LOS ANGELES, CA 90065 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $17 | $7 | $24 | 0.12% |
| COMPASS BENEFITS & INSURANCE SERVIC3 | 5027 DYNASTY WAY SACRAMENTO, CA 95835 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16 | $1 | $17 | 0.08% |
| DENISE M PARADIS3 | 44807 N 7TH STREET NEW RIVER, AZ 85087 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16 | — | $16 | 0.08% |
| ISIDORO ZEICHNER3 | 525 C ST APT 425 SAN DIEGO, CA 92101 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | $3 | $15 | 0.07% |
| FORTRESS INSURANCE SERVICES3 | 20325 N. 51ST AVE STE 134 GLENDALE, AZ 85308 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $14 | — | $14 | 0.07% |
| KRISTINE BROBST3 | 2013 E FRIESS DR PHOENIX, AZ 85022 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | — | $12 | 0.06% |
| TIMOTHY M. JONES3 Filed as: TIMOTHY M JONES | 17075 SAN BRUNO STREET UNIT E FOUNTAIN VALLEY, CA 92708 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | $7 | $12 | 0.06% |
| STEPHEN LEE MILLER3 | 12576 RIDEABOUT COURT SAN DIEGO, CA 92129 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | $1 | $10 | 0.05% |
| GROUP SUPPLEMENTAL BENEFITS INC3 Filed as: GROUP SUPPLEMENTAL BENEFITS INC. | 31805 TEMECULA PARKWAY TEMECULA, CA 92592 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | $4 | $9 | 0.04% |
| NATHAN MATAY3 | 18952 PUEBLO CIRCLE HUNTINGTON BEACH, CA 92646 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | — | $8 | 0.04% |
| MICHAEL C WALKER3 Filed as: MICHAEL J MINNEY | P.O. BOX 365 POWAY, CA 92074 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | $1 | $8 | 0.04% |
| JACK ALLEN NORRIS3 Filed as: JACK WU | 821 BULINGTON ST FILLMORE, CA 93015 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | $1 | $8 | 0.04% |
| JAKORP INC3 Filed as: JAKORP INC. | P.O. BOX 27207 SAN DIEGO, CA 92193 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | — | $7 | 0.03% |
| ANTHONY THOMAS THIELGES3 | 8377 HIDDEN HILLS DR LAS VEGAS, NV 89123 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | $1 | $7 | 0.03% |
| GEORGE E GENTRY3 | 9140 W COOLBROOK AVE PEORIA, AZ 85382 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | — | $6 | 0.03% |
| SAMUEL TADLOCK3 | 7880 WITHERS WAY CORONA, CA 92880 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.02% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT MICHAEL ANASAGASTI | 5208 SOUTH GOLDLEAF PL CHANDLER, AZ 85249 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.01% |
| GABRIELLA JUANITA WOOLARD3 | 2145 EAST ELECTRA LN PHOENIX, AZ 85024 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.01% |
| MARIANNA REBECCA WEAVER3 | 1301 DOVE STREET NEWPORT BEACH, CA 92660 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | $1 | $3 | 0.01% |
| BMG MARKETING GROUP3 | 1191 MAGNOLIA AVE CORONA, CA 92879 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.01% |
| OMEGA FINANCIAL AND INSURANCE SOLUT3 | 4663 CREEPING FIG CT LAS VEGAS, NV 89129 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | $1 | $2 | 0.01% |
| DENISE PATRICIA MERIDITH3 Filed as: DENISE PATRICIA | 1201 E PALO VERDE DRIVE PHOENIX, AZ 85014 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| AUTHORIZED BENEFIT PLANS INS3 Filed as: AUTHORIZED BENEFIT PLANS INC. | 430 W WARNER RD TEMPE, AZ 85284 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $258 | — | $258 | 10.14% |
| KATHRYN LOUISE BALDWIN3 | 3310 E. WISTERIA PLACE CHANDLER, AZ 85286 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $95 | — | $95 | 3.73% |
| SUSAN HENDRICKS3 | 6718 N PALM CANYON DR PHOENIX, AZ 85018 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $73 | $3 | $76 | 2.99% |
| ZULMA YESENIA MAZARIEGOS3 | 302 E CHESTNUT AVE SANTA ANA, CA 92701 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $63 | — | $63 | 2.48% |
| JAROLD L WELKER3 | 1922 N 45TH ST PHOENIX, AZ 85008 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | $1 | $13 | 0.51% |
| GROUP SUPPLEMENTAL BENEFITS INC3 Filed as: GROUP SUPPLEMENTAL BENEFITS INC. | 31805 TEMECULA PARKWAY TEMECULA, CA 92592 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | $4 | $9 | 0.35% |
| GENTRY INSURANCE INC3 Filed as: GENTRY INSURANCE INC. | 9140 W COOLBROOK AVE PEORIA, AZ 85382 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.20% |
| SAMUEL TADLOCK3 | 3713 LYNWOOD DR HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.20% |
| GEORGE E GENTRY3 | 9140 W COOLBROOK AVE PEORIA, AZ 85382 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.04% |
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 | 70 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 70 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 70 | $704K |
| Dental | GUARDIAN | 148 | $67K |
| Vision | GUARDIAN | 148 | $67K |
| Life insurance(2 contracts) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 53 | $23K |
| Short-term disability(2 contracts) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 53 | $23K |
| Other(2 contracts) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 53 | $23K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 148 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.