| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KRISTIN LEASE3 | 3890 HOWARD AVE LOS ALAMITOS, CA 90720 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $984 | $2K | $3K | 6.56% |
| MCCAREY INC3 | 6320 GREENHAVEN DR CARLSBAD, CA 92009 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $75 | $2K | 4.48% |
| LAMBERT MONTALBO3 | 26197 MIRANDA ST HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $837 | — | $837 | 1.94% |
| RONNY ANN WARNER3 | 470 E WHITBECK ST KUNA, ID 83634 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $405 | $119 | $524 | 1.21% |
| LISA ANN MCLAUGHLIN3 | 3031 0 HORSETHIEF DR TEHACHAPI, CA 93561 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $387 | — | $387 | 0.90% |
| JOHN A. BRADLEY INC.3 Filed as: JOHN A BRADLEY INC | 207 SOUTH MAIN ST FOUNTAIN INN, SC 29644 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $242 | — | $242 | 0.56% |
| SUSAN GOLD STOKES3 | 104 MISTY HOLLOW WAY HUNTSVILLE, AL 35806 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $214 | — | $214 | 0.49% |
| R & B ENROLLMENT SERVICES INC3 | PO BOX 3216 CRESTLINE, CA 92325 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $205 | — | $205 | 0.47% |
| ANDREA MARIE TIERCE3 | 1199 MADRONE LN PLACERVILLE, CA 95667 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $156 | — | $156 | 0.36% |
| SUSIE A ESTRADA3 | 25742 PARK AVE SAN JUAN CAPISTRANO, CA 92675 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $129 | $17 | $146 | 0.34% |
| DUANE A ADAMS3 Filed as: DUANE ANDREW FRY | 3707 ANITA AVE PASADENA, CA 91107 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $41 | — | $41 | 0.09% |
| DEL DOWNEY3 | 32056 MERLOT ERST TEMECULA, CA 92591 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $35 | — | $35 | 0.08% |
| UZIEL RIVERA3 | 1267 SILVER TOUCH DR BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $28 | $1 | $29 | 0.07% |
| PAWFORMERS LLC3 | 7 REGAL WAY SIMPSONVILLE, SC 29681 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $20 | — | $20 | 0.05% |
| CHOICE BENEFITS SOLUTIONS LLC3 Filed as: CHOICE BENEFITS SOLUTIONS LIE | 11399 81ST PL SEMINOLE, FL 33772 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | — | $12 | 0.03% |
| STACI MARIE FERRARIS3 | 28912 GLENROCK PL HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | — | $7 | 0.02% |
| ELTHON ISRAEL CRUZ3 | 893 S 2100 W OREM, UT 84059 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.01% |
| LNSYNC BENEFITS INC3 | PO BOX 1474 CORNELIUS, NC 28031 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.01% |
| LORI LAINE3 | 34676 CONADRIA AVE YUCAIPA, CA 92399 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | $1 | $2 | 0.00% |
| JOHN ANTHONY CARREIRO III3 Filed as: JOHN ANTHONY CARREIRO | 11750 CAPRI CIR S APT 3 TREASURE ISLAND, FL 33706 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| MARIA C GONZALEZ3 | 11677 SANDPIPER CT MORENO VALLEY, CA 92557 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| JOSEPH PALOUKOS | 721 SOUTH PARKER SUITE 200 ORANGE, CA 92868 | DELTA DENTAL | $2K | — | $2K | 9.15% |
| DIGITAL INSURANCE LLC3 | 200 GALLERIA PKWY SE STE 1950 ATLANTA, GA 30339 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $879 | $583 | $1K | 16.63% |
| JOSEPH PALOUKOS | 721 SOUTH PARKER SUITE 200 ORANGE, CA 92868 | VISION SERVICE PLAN | $252 | — | $252 | 9.10% |
| BROWN AND BROWN OF FLORIDA, INC. Filed as: WORD & BROWN | 721 SOUTH PARKER SUITE 200 ORANGE, CA 92868 | DELTA DENTAL | $1K | — | $1K | 475.22% |
| BROWN AND BROWN OF FLORIDA, INC. Filed as: WORD & BROWN | 721 SOUTH PARKER SUITE 200 ORANGE, CA 92868 | VISION SERVICE PLAN | $110 | — | $110 | 478.26% |
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 | 69 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 69 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(2 contracts) | DELTA DENTAL | 40 | $27K |
| Vision(2 contracts) | VISION SERVICE PLAN | 40 | $3K |
| Life insurance(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 69 | $52K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 69 | $9K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 69 | — |
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.