| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 10940 WHITE ROCK ROAD, 2ND FLOOR RANCHO CORDOVA, CA 95670 | CALIFORNIA PHYSICIANS' SERVICE | $56K | $11K | $67K | 2.72% |
| LOCKTON COMPANIES, LLC3 | 725 SOUTH FIGUEROA STREET 35TH FLOOR LOS ANGELES, CA 90017 | CALIFORNIA PHYSICIANS' SERVICE | $42K | — | $42K | 1.73% |
| LOCKTON COMPANIES, LLC3 | 725 SOUTH FIGUEROA STREET 35TH FLOOR LOS ANGELES, CA 90017 | UNITED HEALTHCARE INSURANCE COMPANY | $29K | — | $29K | 10.58% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 21250 HAWTHORNE BOULEVARD SUITE 6009050 TORRANCE, CA 90503 | UNITED HEALTHCARE INSURANCE COMPANY | $1K | — | $1K | 0.52% |
| MCCAREY INC3 Filed as: MCCAREY INC. | 965 MESA DRIVE CAMARILLO, CA 93010 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9K | $12K | $22K | 9.87% |
| MJ INSURANCE3 Filed as: TERI ROLLIN AND VARIOUS AGENTS | UNKNOWN OAK PARK, CA 91377 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7K | $1K | $8K | 3.66% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 21520 HAWTHORNE BOULEVARD TORRANCE, CA 90503 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6K | — | $6K | 2.51% |
| ANDREA MARIE TIERCE3 | 2204 PLEASANTWOOD LANE ESCONDIDO, CA 92026 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $1K | $4K | 1.69% |
| EGLY GARCIA3 | 323 NORTH LARK ELLEN AVENUE WEST COVINA, CA 91791 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $276 | $2K | 1.03% |
| ROSE VILLALON PASQUEL3 | 135 WEST 226TH PLACE CARSON, CA 90745 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $288 | $2K | 0.95% |
| JERRY SHAPIRO3 | 21021 VENTURA BOULEVARD WOODLAND HILLS, CA 91364 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 0.76% |
| LOCKTON COMPANIES, LLC3 | 725 SOUTH FIGUEROA STREET 35TH FLOOR LOS ANGELES, CA 90017 | DELTA DENTAL OF CALIFORNIA | $4K | — | $4K | 2.07% |
| WELLS FARGO INSURANCE SERVICES3 | UNKNOWN COMMERCE, CA 90040 | DELTA DENTAL OF CALIFORNIA | $4K | — | $4K | 1.93% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | PO BOX 3900 SAN FRANCISCO, CA 94139 | AETNA LIFE INSURANCE COMPANY | $2K | $750 | $3K | 8.48% |
| LOCKTON COMPANIES, LLC3 | 725 SOUTH FIGUEROA, 35TH FLOOR LOS ANGELES, CA 90017 | AETNA LIFE INSURANCE COMPANY | $940 | — | $940 | 2.52% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 150 SOUTH LOS ROBLES AVENUE SUITE 850 PASADENA, CA 91101 | AETNA LIFE INSURANCE COMPANY | — | $67 | $67 | 0.18% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 15303 VENTURA BOULEVARD, SUITE 700 SHERMAN OAKS, CA 91403 | AETNA LIFE INSURANCE COMPANY | — | $67 | $67 | 0.18% |
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 | 404 | 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) | 404 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA PHYSICIANS' SERVICE | 472 | $2.5M |
| Dental | DELTA DENTAL OF CALIFORNIA | 404 | $191K |
| Vision | UNITED HEALTHCARE INSURANCE COMPANY | 1,153 | $275K |
| Life insurance(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 404 | $258K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 137 | $220K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 472 | $2.5M |
| Other(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 404 | $258K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,153 | — |
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.