| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KRISTIN LEASE3 | 3890 HOWARD AVE LOS ALAMITOS, CA 90720 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $3K | $5K | 11.14% |
| MCCAREY INC3 | 6320 GREENHAVEN DR CARLSBAD, CA 92009 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $394 | $3K | 5.88% |
| RUBEN ROSALES3 | 435 E 56TH ST LONG BEACH, CA 90805 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $108 | $2K | 4.29% |
| RONNY ANN WARNER3 | 470 E WHITBECK ST KUNA, ID 83634 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $689 | $239 | $928 | 1.91% |
| LISA ANN MCLAUGHLIN3 | 30310 HORSETHIEF DR TEHACHAPI, CA 93561 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $367 | — | $367 | 0.76% |
| HAD LI ENTERPRISES INCORPORATED3 | 11432 SOUTH ST PMB 303 CERRITOS, CA 90703 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $151 | $107 | $258 | 0.53% |
| JOHN A. BRADLEY INC.3 Filed as: JOHN A BRADLEY INC | 207 SOUTH MAIN ST FOUNTAIN INN, SC 29644 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $255 | — | $255 | 0.52% |
| CHOICE BENEFITS SOLUTIONS LLC3 | 11399 81ST PL SEMINOLE, FL 33772 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $255 | — | $255 | 0.52% |
| SUSAN GOLD STOKES3 | 104 MISTY HOLLOW WAY HUNTSVILLE, AL 35806 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $212 | — | $212 | 0.44% |
| R & B ENROLLMENT SERVICES INC3 | PO BOX 3216 CRESTLINE, CA 92325 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $201 | — | $201 | 0.41% |
| LANDON GREGORY HAIRSTON3 | 5645 CAROLINE ST MONTCLAIR, CA 91763 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $151 | $41 | $192 | 0.40% |
| ANDREA MARIE TIERCE3 | 1199 MADRONE LN PLACERVILLE, CA 95667 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $163 | — | $163 | 0.34% |
| DEL DOWNEY3 | 32056 MERLOT CRST TEMECULA, CA 92591 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $36 | — | $36 | 0.07% |
| DUANE A ADAMS3 Filed as: DUANE ANDREW FRY | 3707 ANITA AVE PASADENA, CA 91107 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $24 | — | $24 | 0.05% |
| PAWFORMERS LLC3 | 7 REGAL WAY SIMPSONVILLE, SC 29681 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $19 | — | $19 | 0.04% |
| UZIEL RIVERA3 | 1267 SILVER TORCH DR BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $17 | — | $17 | 0.03% |
| LAMBERT MONTALBO3 | 26197 MIRADA ST HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $13 | — | $13 | 0.03% |
| 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% |
| INSYNC BENEFITS INC3 | PO BOX 1474 CORNELIUS, NC 28031 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | — | $6 | 0.01% |
| JOHN ANTHONY CARREIRO III3 Filed as: JOHN ANTHONY CARREIRO | 11750 CAPRI CIR 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 FFS | $1K | — | $1K | 3.74% |
| BROWN AND BROWN OF FLORIDA, INC. Filed as: WORD & BROWN | 721 SOUTH PARKER SUITE 200 ORANGE, CA 92868 | DELTA DENTAL FFS | $771 | — | $771 | 2.20% |
| SELBY WOODROW | 721 SOUTH PARKER SUITE 200 ORANGE, CA 92868 | DELTA DENTAL FFS | $625 | — | $625 | 1.78% |
| JOSEPH PALOUKOS | 721 SOUTH PARKER SUITE 200 ORANGE, CA 92868 | DELTACARE USA | $422 | — | $422 | 3.75% |
| BROWN AND BROWN OF FLORIDA, INC. Filed as: WORD & BROWN | 721 SOUTH PARKER SUITE 200 ORANGE, CA 92868 | DELTACARE USA | $254 | — | $254 | 2.26% |
| SELBY WOODROW | 721 SOUTH PARKER SUITE 200 ORANGE, CA 92868 | DELTACARE USA | $200 | — | $200 | 1.78% |
| DIGITAL INSURANCE LLC3 | 200 GALLERIA PKWY SE STE 1950 ATLANTA, GA 30339 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $945 | $417 | $1K | 14.41% |
| JOSEPH PALOUKOS | 721 SOUTH PARKER SUITE 200 ORANGE, CA 92868 | VISION SERVICE PLAN | $147 | — | $147 | 3.76% |
| BROWN AND BROWN OF FLORIDA, INC. Filed as: WORD & BROWN | 721 SOUTH PARKER SUITE 200 ORANGE, CA 92868 | VISION SERVICE PLAN | $87 | — | $87 | 2.23% |
| SELBY WOODROW | 721 SOUTH PARKER SUITE 200 ORANGE, CA 92868 | VISION SERVICE PLAN | $69 | — | $69 | 1.77% |
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 | 80 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 80 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN, INC. | 44 | $449K |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL FFS | 34 | $46K |
| Vision | VISION SERVICE PLAN | 34 | $4K |
| Life insurance(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 80 | $58K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 80 | $9K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 80 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.