| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RSC INSURANCE BROKERAGE INC3 Filed as: RSC INSURANCE BROKERAGE, INC. | 160 FEDERAL STREET BOSTON, MA 01982 | BLUE CROSS OF CALIFORNIA | $34K | $15K | $48K | 7.81% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 1600 WEST HILLSDALE BOULEVARD SUITE 201 SAN MATEO, CA 94403 | BLUE CROSS OF CALIFORNIA | $0 | $11K | $11K | 1.82% |
| EMERSON REID LLC3 Filed as: EMERSON REID AND COMPANY, INC. | 1787 SENTRY PARKWAY WEST VEVA 16, SUITE 320 BLUE BELL, PA 19422 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $16K | $0 | $16K | 20.09% |
| JOHN D EVANGELISTA3 Filed as: JOHN D. EVANGELISTA | 151 LAS FLORES ALISO VIEJO, CA 92656 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $5K | $7K | $11K | 36.92% |
| RSC INSURANCE BROKERAGE INC3 Filed as: RSC INSURANCE BROKERAGE, INC. | 160 FEDERAL STREET BOSTON, MA 01982 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $5K | $1K | $7K | 21.21% |
| LUIS RAFAEL VALLE3 Filed as: LUIS RAFAEL VALLE AND OTHER AGENTS | 2354 CHATKA LANE SAN BERNARDINO, CA 92410 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $583 | $3K | 9.23% |
| GOLD RIVER FINANCIAL GROUP LLC3 Filed as: GOLD RIVER FINANCIAL GROUP, LLC | 2807 GRATTON STREET RIVERSIDE, CA 92504 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $644 | $2K | 6.25% |
| BENEFITS COORDINATOR3 | 10741 LA JARA STREET CERRITOS, CA 90703 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $712 | $737 | $1K | 4.66% |
| TECH COORDINATOR CYBER INSURANCE SO3 Filed as: TECH COORDINATOR CYBER INSURANCE | 10741 LA JARA STREET CERRITO, CA 90703 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $744 | $270 | $1K | 3.26% |
| JIMMY CHUON TCHEN3 | 15904 KENNARD STREET HACIENDA HEIGHTS, CA 91745 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $314 | $280 | $594 | 1.91% |
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 | 121 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 122 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 156 | $621K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 147 | $78K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 147 | $78K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 147 | $78K |
| Short-term disability | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 66 | $31K |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 156 | $621K |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 147 | $109K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 156 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.