| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EVCO INSURANCE SERVICES INC3 Filed as: EVCO INSURANCE SERVICES | — | KAISER PERMANENTE | $5K | — | $5K | 5.00% |
| CLAREMONT BUSINESS GROUP3 Filed as: CLAREMONT INSURANCE COMPANY | — | KAISER PERMANENTE | $3K | — | $3K | 2.66% |
| EVCO INSURANCE SERVICES INC3 Filed as: EVCO INSURANCE SERVICES | — | ANTHEM BLUE CROSS | $2K | — | $2K | 5.00% |
| CLAREMONT BUSINESS GROUP3 Filed as: CLAREMONT INSURANCE COMPANY | — | ANTHEM BLUE CROSS | $838 | — | $838 | 2.66% |
| EVCO INSURANCE SERVICES INC3 Filed as: EVCO INSURANCE SERVICES | — | SUTTER HEALTH PLUS | $1K | — | $1K | 5.00% |
| CLAREMONT BUSINESS GROUP3 Filed as: CLAREMONT INSURANCE COMPANY | — | SUTTER HEALTH PLUS | $594 | — | $594 | 2.66% |
| EVCO INSURANCE SERVICES INC3 Filed as: EVCO INSURANCE SERVICES | — | HEALTH NET | $469 | — | $469 | 5.00% |
| CLAREMONT BUSINESS GROUP3 Filed as: CLAREMONT INSURANCE COMPANY | — | HEALTH NET | $249 | — | $249 | 2.66% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 2 ENTERPRISE DR STE 204 SHELTON, CT 06484 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $464 | $464 | 5.00% |
| EVCO INSURANCE SERVICES INC3 Filed as: EVCO INSURANCE SERVICES, INC. | 1212 BROADWAY PLZ STE 2100 WALNUT CREEK, CA 94596 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $464 | — | $464 | 5.00% |
| DANIEL J BAZIS3 | 9218 S 168TH AVE CIR OMAHA, NE 68136 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $290 | $377 | $667 | 15.18% |
| EVCO INSURANCE SERVICES INC3 | 1212 BROADWAY PLAZA WALNUT CREEK, CA 94596 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $408 | — | $408 | 9.28% |
| BRIAN ROBERT LLOYD3 | 6234 KINGS PEAK DR EL DORADO HILLS, CA 95762 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $65 | $169 | $234 | 5.32% |
| CASEY JAMES KUGLER3 | 21068 VALLEY CIR ELKHORN, NE 68022 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $23 | $173 | $196 | 4.46% |
| BRITTANY LLOYD3 | 6234 KINGS PEAK DR EL DORADO HILLS, CA 95762 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $58 | $66 | $124 | 2.82% |
| STEPHANIE NOELLE KUGLER3 | 21068 VALLEY CIR ELKHORN, NE 68022 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $78 | $34 | $112 | 2.55% |
| MARGARITA ALEJANDRA RAMIREZ3 | 1356 CALLE COLNETT SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | — | $8 | 0.18% |
| EVCO INSURANCE SERVICES INC3 Filed as: EVCO INSURANCE SERVICES, INC. | 1212 BROADWAY PLZ STE 2100 WALNUT CREEK, CA 94596 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $459 | — | $459 | 18.01% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 2 ENTERPRISE DR STE 204 SHELTON, CT 06484 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $127 | $127 | 4.98% |
| EVCO INSURANCE SERVICES INC3 Filed as: EVCO INSURANCE SERVICES, INC. | 1212 BROADWAY PLZ STE 2100 WALNUT CREEK, CA 94596 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $158 | — | $158 | 9.99% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 2 ENTERPRISE DR STE 204 SHELTON, CT 06484 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $79 | $79 | 4.99% |
| EVCO INSURANCE SERVICES INC3 Filed as: EVCO INSURANCE SERVICES, INC. | 1212 BROADWAY PLZ STE 2100 WALNUT CREEK, CA 94596 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $44 | — | $44 | 11.99% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 2 ENTERPRISE DR STE 204 SHELTON, CT 06484 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $18 | $18 | 4.90% |
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | KAISER PERMANENTE | 0 | $164K |
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 134 | $9K |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 116 | $2K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 264 | $3K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 0 | $4K |
| Other(3 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 264 | $7K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 264 | — |
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.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.