| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HEFFERNAN INSURANCE BROKERS3 | PO BOX 4006 WALNUT CREEK, CA 94596 | KAISER FOUNDATION HEALTH PLAN | $22K | — | $22K | 2.70% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL | 600 HIGHWAY 169 S FL 12 SAINT LOUIS PARK, MN 55426 | KAISER FOUNDATION HEALTH PLAN | -$183 | — | -$183 | -0.02% |
| HEFFERNAN INSURANCE BROKERS3 | PO BOX 4006 WALNUT CREEK, CA 94596 | SUN LIFE ASSURANCE COMPANY OF CANADA | $2K | — | $2K | 3.34% |
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVE STE 200 WALNUT CREEK, CA 94596 | SUN LIFE ASSURANCE COMPANY OF CANADA | $905 | — | $905 | 1.35% |
| PETRA PACIFIC INSURANCE SERVICE INC3 Filed as: PETRA PACIFIC INSURANCE SERVICE | 13950 CERRITOS CORPORATE DR STE A CERRITOS, CA 90703 | SUN LIFE ASSURANCE COMPANY OF CANADA | $880 | — | $880 | 1.31% |
| HEFFERNAN INSURANCE BROKERS3 | PO BOX 4006 WLANUT CREEK, CA 94596 | SUN LIFE ASSURANCE COMPANY OF CANADA | $3K | — | $3K | 10.79% |
| PETRA PACIFIC INSURANCE SERVICE INC3 | 13950 CERRITOS CORPORATE DR STE A CERRITOS, CA 90703 | SUN LIFE ASSURANCE COMPANY OF CANADA | $1K | — | $1K | 3.62% |
| HEFFERNAN INSURANCE BROKERS3 | PO BOX 5608 WALNUT CREEK, CA 94596 | VISION SERVICE PLAN | $555 | — | $555 | 5.19% |
| PETRA PACIFIC INSURANCE SERVICE INC3 Filed as: PETRA PACIFIC INSURANCE SERVICE | 13950 CERRITOS CORPORATED DR CERRITOS, CA 90703 | VISION SERVICE PLAN | $215 | — | $215 | 2.01% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL | 21250 HAWTHRONE BLVD TORRANCE, CA 90503 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $943 | — | $943 | 11.89% |
| JOHN D EVANGELISTA3 | 26111 ANTONIO PARKWAY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $236 | $72 | $308 | 3.88% |
| BENEFITS COORDINATOR3 | 29448 TOURS STREET LAKE ELSINORE, CA 92530 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $171 | $46 | $217 | 2.74% |
| MARIA C GONZALEZ3 | 11677 SANDPIPER CT MORENO VALLEY, CA 92557 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $161 | $15 | $176 | 2.22% |
| ERIC NOVOA3 | 17871 SHAY VIEW DR CHINO HILLS, CA 91709 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $126 | $22 | $148 | 1.87% |
| SARAH COURTNEY KNAPP3 | 61 SKLAR LADERA RANCH, CA 92694 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $107 | $6 | $113 | 1.42% |
| MARTHA R BAEZ3 | 2179 OLD BRIDGE RD RIVERSIDE, CA 92506 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $91 | $5 | $96 | 1.21% |
| UZIEL RIVERA3 | 1267 SILVER TORCH DRIVE BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $36 | $14 | $50 | 0.63% |
| LIFE TIME SOLUTIONS LLC3 | 861 KENWOOD ST UPLAND, CA 91784 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $31 | — | $31 | 0.39% |
| GOLD RIVER FINANCIAL GROUP LLC3 | 2807 GRATTON ST RIVERSIDE, CA 92504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $27 | $4 | $31 | 0.39% |
| STEPHEN W DOUGLASS3 | 45 MORNING GLORY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $28 | — | $28 | 0.35% |
| CONSUMER DRIVEN BENEFITS LLC3 | 3737 BIRCH ST NEWPORT BEACH, CA 92660 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | $7 | $12 | 0.15% |
| LUIS RAFAEL VALLE3 | 2354 CHATKA LANE SAN BERNARDINO, CA 92410 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.06% |
| STACI MARIE FERRARIS3 | 28912 GLEN ROCK PLACE HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.05% |
| SUSAN GOLD STOKES3 Filed as: SUSAN G STOKES | 3113 W 187TH PL TORRANCE, CA 90504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.05% |
| SA GENERAL AGENCY INC3 | 9385 MILLER LANE GARDEN RIDGE, TX 78266 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.05% |
| ASCENSION BENEFITS ADVISORS3 | 6 POMERGRANATE ST LADERA RANCH, CA 92694 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.04% |
| FBP INSURANCE SERVICES3 Filed as: FBP INSURNACE SERVICES | 130 THEORY IRVINE, CA 92617 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.04% |
| PROFESSIONAL ENROLLMENT CONCEPTS3 | 7922 WESTGLEN DRIVE HOUSTON, TX 77063 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.03% |
| EDWIN MANUEL VELASQUEZ3 | 33013 SEVILLE ST LAKE ELSINORE, CA 92530 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.03% |
| HORIZON BENEFITS LLC3 | 9385 MILLER LANE GARDEN RIDGE, TX 78266 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.01% |
| MARIA YVONNE RODIGHIERO3 | 28502 SHRIKE DRIVE LAGUNA NIGUEL, CA 92677 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.01% |
| RONALD PERALEZ3 | 18 SEPULVEDA RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.01% |
| CALVIN DEAN INGLE3 | 1840 LARIAT TRAIL CELINA, TX 75009 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.01% |
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 | 162 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 162 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN | 162 | $808K |
| Dental | SUN LIFE ASSURANCE COMPANY OF CANADA | 80 | $67K |
| Vision | VISION SERVICE PLAN | 1 | $11K |
| Life insurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 109 | $40K |
| Short-term disability(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 109 | $40K |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 109 | $40K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 162 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.