| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MCCAREY INC3 | 6320 GREENHAVEN DR CARLSBAD, CA 92009 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $240 | $2K | 4.49% |
| UZIEL RIVERA3 | 1267 SILVER TORCH DR BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $424 | $172 | $596 | 1.46% |
| DUANE A ADAMS3 Filed as: DUANE ANDREW FRY | 3707 ANITA AVE PASADENA, CA 91107 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $497 | $88 | $585 | 1.43% |
| LISA ANN MCLAUGHLIN3 | 30310 HORSETHIEF DR TEHACHAPI, CA 93561 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $449 | — | $449 | 1.10% |
| RONNY ANN WARNER3 | 470 E WHITBECK ST KUNA, ID 83634 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $289 | $126 | $415 | 1.01% |
| JOHN A. BRADLEY INC.3 Filed as: JOHN A BRADLEY INC | 207 SOUTH MAIN ST FOUNTAIN INN, SC 29644 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $324 | — | $324 | 0.79% |
| R & B ENROLLMENT SERVICES INC3 | PO BOX 3216 CRESTLINE, CA 92325 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $266 | — | $266 | 0.65% |
| SUSAN GOLD STOKES3 | 104 MISTY HOLLOW WAY HUNTSVILLE, AL 35806 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $244 | $1 | $245 | 0.60% |
| ANDREA MARIE TIERCE3 | 1199 MADRONE LN N 111 PLACERVILLE, CA 95667 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $191 | — | $191 | 0.47% |
| LORI LAINE3 | 34676 CONADRIA AVE YUCAIPA, CA 92399 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $63 | $50 | $113 | 0.28% |
| DEL DOWNEY3 | 32056 MER1OT CRST TEMECULA, CA 92591 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $62 | — | $62 | 0.15% |
| PAWFORMERS LIE3 | 7 REGAL WAY SIMPSONVILLE, SC 29681 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $23 | — | $23 | 0.06% |
| CHOICE BENEFITS SOLUTIONS LLC3 | 11399 81ST PL SEMINOLE, FL 33772 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $15 | — | $15 | 0.04% |
| STACI MARIE FERRARIS3 | 28912 GLENROCK PL HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | — | $8 | 0.02% |
| ELTHON ISRAEL CRUZ3 | 893 S 2100 W OREM, UT 84059 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | — | $6 | 0.01% |
| LNSYNC BENEFITS INC3 | PO BOX 1474 CORNELIUS, NC 28031 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | — | $6 | 0.01% |
| MARIA C GONZALEZ3 | 11677 SANDPIPER CT MORENO VALLEY, CA 92557 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| JOSEPH PALOUKOS | 525 20TH STREET SAN FRANCISCO, CA 94017 | CHOICEBUILDER INSURANCE SERVICES | $3K | — | $3K | 10.00% |
| BROWN AND BROWN OF FLORIDA, INC. Filed as: WORD & BROWN | 721 SOUTH PARKER ORANGE, CA 92868 | CHOICEBUILDER INSURANCE SERVICES | $1K | — | $1K | 4.00% |
| DIGITAL INSURANCE LLC3 | 200 GALLERIA PKWY SE STE 1950 ATLANTA, GA 30339 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $879 | — | $879 | 10.00% |
| DIGITAL INSURANCE LLC3 | 200 GALLERIA PKWY SE STE 1950 ATLANTA, GA 30339 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $583 | $583 | 6.63% |
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 | 73 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 73 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN, INC. | 73 | $529K |
| Dental | CHOICEBUILDER INSURANCE SERVICES | 40 | $30K |
| Vision | CHOICEBUILDER INSURANCE SERVICES | 40 | $30K |
| Life insurance(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 69 | $50K |
| Other | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 25 | $41K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 73 | — |
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."
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.