| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LIBERTY COMPANY INSURANCE BROKERS3 Filed as: THE LIBERTY COMPANY INS. BROKERS | 5955 DE SOTO AVENUE WOODLAND HILLS, CA 91367 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $669 | $0 | $669 | 8.37% |
| JOHN D EVANGELISTA3 Filed as: JOHN D. EVANGELISTA | 186 LAS FLORES ALISO VIEJO, CA 92656 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $183 | $6 | $189 | 2.37% |
| SARAH COURTNEY KNAPP3 | 61 SKLAR LADERA RANCH, CA 92694 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $89 | $6 | $95 | 1.19% |
| TECH COORDINATOR CYBER INSURANCE SO3 | 10741 LA JARA STREET CERRITOS, CA 90703 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $58 | $1 | $59 | 0.74% |
| LUIS RAFAEL VALLE3 Filed as: LUIS RAFAEL VALLE AND OTHER AGENTS | 2354 CHATKA LANE SAN BERNARDINO, CA 92410 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $32 | $0 | $32 | 0.40% |
| LUIS ERNESTO PEREZ3 Filed as: LUIS PEREZ BENEFIT INS. SOLUTION | 861 KENWOOD STREET UPLAND, CA 91784 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $26 | $0 | $26 | 0.33% |
| MARIA C GONZALEZ3 Filed as: MARIA C. GONZALEZ | 11677 SANDPIPER COURT MORENO VALLEY, CA 92557 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $23 | $3 | $26 | 0.33% |
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 143 | $8K |
| Life insurance | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 143 | $8K |
| Other | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 143 | $8K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 143 | — |
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.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.