| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RICHARD W SHELTON INS. MARKETING3 | 719 SAN BENITO ST., SUITE B HOLLISTER, CA 95023 | PREMIER ACCESS INSURANCE COMPANY | $14K | $0 | $14K | 10.00% |
| RICHARD W SHELTON INS. MARKETING3 | 719 SAN BENITO ST., SUITE B HOLLISTER, CA 95023 | PREMIER ACCESS INSURANCE COMPANY | $2K | $0 | $2K | 10.00% |
| MICHAEL KEITH MCDONOUGH3 | 130 CUMBERLAND WAY ALAMEDA, CA 94502 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $0 | $1K | 8.84% |
| BEVERLY M SEMMENS3 Filed as: BEVERLY WARD BERGTHOLD | 1043 NORMINGTON WAY SAN JOSE, CA 95136 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $329 | $4 | $333 | 2.73% |
| MARK TETSUO IWASAKI3 | 133 CRABAPPLE CT HERCULES, CA 94547 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $202 | $0 | $202 | 1.66% |
| CATHERINE LISA LUKE3 | 1922 THE ALAMEDA STE. 212 SAN JOSE, CA 95126 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $97 | $100 | $197 | 1.61% |
| MICHAEL JAMES LEBRANE3 | 808 EAST 5TH AVE SAN MATEO, CA 94402 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $120 | $2 | $122 | 1.00% |
| SARAH PALOMINO-GAETA3 | 16725 FOUNTAIN AVE MORGAN HILL, CA 95037 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $100 | $3 | $103 | 0.84% |
| MICHAEL KIRKPATRICK3 | PO BOX 270 FREEDOM, CA 95050 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $88 | $0 | $88 | 0.72% |
| DOUGLAS LOYAL NERDAHL3 | 41 W 4TH AVE SAN MATEO, CA 94402 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $88 | $0 | $88 | 0.72% |
| STOP LOSS INSURANCE SERVICES, INC.3 Filed as: STOP LOSS INSURANCE SERVICES INC. | PO BOX 845052 LOS ANGELES, CA 90084 | SUN LIFE ASSURANCE COMPANY OF CANADA | $2K | $0 | $2K | 15.00% |
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 | 147 | 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) | 147 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | PREMIER ACCESS INSURANCE COMPANY | 273 | $139K |
| Vision | PREMIER ACCESS INSURANCE COMPANY | 264 | $23K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 0 | $12K |
| Other(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 26 | $24K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 273 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.