| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MICHAEL B. KELLY INSURANCE3 | P. O. BOX 222634 CARMEL, CA 939222634 | METROPOLITAN LIFE INSURANCE COMPANY | $45K | — | $45K | 9.94% |
| AMWINS3 Filed as: LISI, LLC | 2677 N MAIN STREET, SUITE 800 SANTA ANA, CA 92705 | METROPOLITAN LIFE INSURANCE COMPANY | $21K | $1K | $22K | 4.86% |
| MICHAEL B. KELLY INSURANCE3 | P. O. BOX 222634 CARMEL, CA 939222263 | VISION SERVICE PLAN | $2K | — | $2K | 3.14% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS | — | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6K | $3K | $9K | 35.14% |
| MICHAEL B. KELLY INSURANCE3 Filed as: MICHAEL B KELLY INSURANCE SERVICES | PO BOX 222634 CARMEL, CA 93922 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6K | $275 | $6K | 21.68% |
| SALVADOR HEREDIA3 | 700 EL CAMINITO LIVERMORE, CA 94550 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $662 | $3K | 12.27% |
| STEPHANIE NOELLE KUGLER3 | 21068 VALLEY CIRCLE ELKHORN, NE 68022 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $878 | $592 | $1K | 5.47% |
| UZIEL RIVERA3 | 1267 SILVER TORCH DRIVE BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $180 | $73 | $253 | 0.94% |
| ALICIA FRANKLIN3 | 5799 ESTATES DRIVE OAKLAND, CA 94618 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $42 | — | $42 | 0.16% |
| MARGARITA ALEJANDRA RAMIREZ3 | 1356 CALLE COLNETT SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $29 | $13 | $42 | 0.16% |
| STEPHANIE NOELLE KUGLER3 | 21068 VALLEY CIRCLE ELKHORN, NE 68022 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $373 | $4K | 23.46% |
| MICHAEL B. KELLY INSURANCE3 Filed as: MICHAEL B KELLY INSURANCE SERVICES | PO BOX 222634 CARMEL, CA 93922 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $169 | $4K | 21.43% |
| BRITTANY LLOYD3 | 6234 KINGS PEAK DRIVE ELDORADO HILLS, CA 95762 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $2K | $3K | 19.49% |
| MARGARITA ALEJANDRA RAMIREZ3 | 1356 CALLE COLNETT SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $616 | $273 | $889 | 5.31% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS | — | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $279 | $524 | $803 | 4.80% |
| DEACON CHARLES KAVANAUGH3 | 6336 HILL CREEK DRIVE THE COLONY, TX 75056 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $188 | $24 | $212 | 1.27% |
| MELISSA MARIE MARTINO3 | 15904 KENNARD STREET HACIENDA HEIGHTS, CA 91745 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $91 | — | $91 | 0.54% |
| MICHAEL B. KELLY INSURANCE3 Filed as: MICHAEL B KELLY INSURANCE SERVICES | PO BOX 222634 CARMEL, CA 93922 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $56 | $1K | 24.95% |
| BRITTAN LLOYD3 | 6234 KINGS PEAK DRIVE EL DORADO HILLS, CA 95762 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $522 | $554 | $1K | 22.54% |
| MARGARITA ALEJANDRA RAMIREZ3 | 1356 CALLE COLNETT SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $450 | $199 | $649 | 13.59% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 2677 N MAIN STREET SANTA ANA, CA 92705 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $613 | — | $613 | 12.84% |
| SALVADOR HEREDIA3 | 700 EL CAMINITO LIVERMORE, CA 94550 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $302 | $76 | $378 | 7.92% |
| STEPHANIE NOELLE KUGLER3 | 21068 VALLEY CIRCLE ELKHORN, NE 68022 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $186 | $125 | $311 | 6.51% |
| LUIS ERNESTO PEREZ3 Filed as: LUIS PEREZ BENEFIT INSURANCE SOLUTI | 861 KENWOOD STREET UPLAND, CA 91784 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $24 | $9 | $33 | 0.69% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MICHAEL B. KELLY INSURANCE EIN 30-0540100 BROKER | Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | P. O. BOX 222634 CARMEL, CA 93922 | $136K |
| COASTAL TPA EIN 77-0523382 TPA | Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | P. O. BOX 80308 SALINAS, CA 93912 | $130K |
| ANTHEM BLUE CROSS EIN 95-3760980 CARRIER + NETWORK | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 13 | P. O. BOX 511300 LOS ANGELES, CA 90051 | $85K |
| FIRST HEALTH EIN 20-1736437 CARRIER | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 13 | 23291 NETWORK PLACE CHICAGO, IL 60673 | $7K |
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 | 453 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 456 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 875 | $454K |
| Vision | VISION SERVICE PLAN | 418 | $67K |
| Other(3 contracts) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 55 | $48K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 875 | — |
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.