| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RIS EMPLOYEE BENEFITS INC3 Filed as: RIS EMPLOYEE BENEFITS, INC. | 221 MAIN STREET UNIT 1462 LOS ALTOS, CA 94023 | BLUE SHIELD OF CALIFORNIA CALIFORNIA PHYSICIANS' SERVICE | $2K | $98K | $101K | 4.23% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | BLUE SHIELD OF CALIFORNIA CALIFORNIA PHYSICIANS' SERVICE | $48K | $2K | $50K | 2.08% |
| MICHAEL KIRKPATRICK3 | PO BOX 270 FREEDOM, CA 95019 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $539 | $0 | $539 | 1.55% |
| MIKE RADAKOVICH3 Filed as: MIKE GEORGE RADAKOVICH | 221 MAIN STREET UNIT 1462 LOS ALTOS, CA 94023 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $387 | $0 | $387 | 1.12% |
| CATHERINE LISA LUKE3 | 9351 OAK VIEW DRIVE OAKDALE, CA 95361 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $231 | $0 | $231 | 0.67% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 2860 GOLF ROAD ROLLING MEADOWS, IL 60008 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $187 | $0 | $187 | 0.54% |
| MARK TETSUO IWASAKI3 | 133 CRABAPPLE CT HERCULES, CA 94547 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $140 | $0 | $140 | 0.40% |
| DONNA MARIE STOLL3 | 502 BOB LITTLE RD PANAMA CITY, FL 32404 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $39 | $0 | $39 | 0.11% |
| SCOTT E BOORE3 | 1680 DELTA WIND LANE LINCOLN, CA 95648 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $38 | $0 | $38 | 0.11% |
| ELTHON ISRAEL CRUZ3 | 893 S 2100 W OREM, UT 84059 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $38 | $0 | $38 | 0.11% |
| R & B ENROLLMENT SERVICES INC3 Filed as: R AND B ENROLLMENT SERVICES INC | PO BOX 3216 CRESTLINE, CA 92325 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $22 | $0 | $22 | 0.06% |
| MICHAEL JAMES LEBRANE3 | 808 E 5TH AVE APT A SAN MATEO, CA 94402 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $20 | $0 | $20 | 0.06% |
| PATRICIA FERNANDEZ3 | 4005 E OSBORN RD PHOENIX, AZ 85018 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $19 | $0 | $19 | 0.05% |
| REBECCA J MERRITT3 | 927 E KEIM DRIVE PHOENIX, AZ 95014 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $7 | $0 | $7 | 0.02% |
| SUSAN HENDRICKS3 | 6718 N PALM CANYON DR. PHOENIX, AZ 85018 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $4 | $0 | $4 | 0.01% |
| JOSEPH QUINTANA3 | 3022 N 49TH CT PHOENIX, AZ 85018 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3 | $0 | $3 | 0.01% |
| THOMAS MARTIN LEVINSTEIN3 | 16 PHEASANT LANE ALISO VIEJO, CA 92656 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2 | $0 | $2 | 0.01% |
| JOHN A. BRADLEY INC.3 Filed as: JOHN A BRADLEY INC. | 207 SOUTH MAIN STREET FOUNTAIN INN, SC 29644 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1 | $0 | $1 | 0.00% |
| RIS EMPLOYEE BENEFITS INC3 Filed as: RIS EMPLOYEE BENEFITS, INC. | 221 MAIN STREET UNIT 1462 LOS ALTOS, CA 94023 | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | $2K | $0 | $2K | 10.00% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | $326 | $0 | $326 | 2.00% |
| MIKE RADAKOVICH3 | 221 MAIN STREET UNIT 1492 LOS ALTOS, CA 94023 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $0 | $3K | 20.00% |
| ANT FARM3 | 291 HERTIAGE WALK WOODSTOCK, GA 30188 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $719 | $719 | 5.00% |
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 | 196 | 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) | 196 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE SHIELD OF CALIFORNIA CALIFORNIA PHYSICIANS' SERVICE | 411 | $2.4M |
| Vision | BLUE SHIELD OF CALIFORNIA CALIFORNIA PHYSICIANS' SERVICE | 411 | $2.4M |
| Life insurance(3 contracts, 3 carriers) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 194 | $65K |
| Short-term disability | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 27 | $35K |
| Other(2 contracts, 2 carriers) | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | 194 | $31K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 411 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
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.