| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE ITASCA, IL 60143 | BLUE CROSS OF CALIFORNIA | $100K | $0 | $100K | 4.52% |
| DOCHTERMAN INSURANCE SERVICES, INC.3 Filed as: DOCHTERMAN INSURANCE SERVICES | 908 SOUTH VILLAGE OAKS DRIVE SUITE 250 COVINA, CA 91724 | BLUE CROSS OF CALIFORNIA | $8K | $0 | $8K | 0.38% |
| GALLAGHER BENEFIT SERVICES, INC.3 | UNKNOWN WOODLAND HILLS, CA 91365 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $675 | $6 | $681 | 9.27% |
| MCCAREY INC3 | 965 MESA DRIVE CAMARILLO, CA 93010 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $196 | $11 | $207 | 2.82% |
| MARTHA ANGELICA HILL ESTRADA3 | 2991 ESCALA CIRCLE SAN DIEGO, CA 92108 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $86 | $19 | $105 | 1.43% |
| ANDREA MARIE TIERCE3 | 2204 PLEASANTWOOD LANE ESCONDIDO, CA 92026 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $85 | $7 | $92 | 1.25% |
| MARIA YVONNE RODIGHIERO3 | 28502 SHRIKE DRIVE LAGUNA NIGUEL, CA 92677 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $50 | $0 | $50 | 0.68% |
| MARGARITA ALEJANDRA RAMIREZ3 | 1356 CALLE COLNETT SAN MARCOS, CA 92069 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $41 | $0 | $41 | 0.56% |
| MJ INSURANCE3 Filed as: DEL DOWNEY AND VARIOUS AGENTS | 32056 MERLOT CREST TEMECULA, CA 92591 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $35 | $0 | $35 | 0.48% |
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 | 200 | 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) | 200 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 385 | $2.2M |
| Dental | BLUE CROSS OF CALIFORNIA | 385 | $2.2M |
| Vision | BLUE CROSS OF CALIFORNIA | 385 | $2.2M |
| Life insurance | BLUE CROSS OF CALIFORNIA | 385 | $2.2M |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 385 | $2.2M |
| Other(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 385 | $2.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 385 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.