| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BRADAWN INSURANCE SERVICES, INC. Filed as: BRADAWN INSURANCE SERVICES INC | 500 LA TERRAZA BLVD STE 102 ESCONDIDO, CA 92025 | ROCKY MOUNTAIN HOSPITAL & MEDICAL SERVICE, INC. | $10K | $0 | $10K | 1.51% |
| GALLAGHER BENEFIT SERVICES, INC. Filed as: GALLAGHER BENEFIT SERVICES INC | 323 WEST LAKESIDE AVENUE SUITE 410 CLEVELAND, OH 44113 | ROCKY MOUNTAIN HOSPITAL & MEDICAL SERVICE, INC. | $7K | — | $7K | 1.03% |
| BRADAWN INSURANCE SERVICES, INC. Filed as: BRADAWN INSURANCE SERVICES INC | 500 LA TERRAZA BLVD STE 102 ESCONDIDO, CA 92025 | VISION SERVICE PLAN | $2K | — | $2K | 2.72% |
| GALLAGHER BENEFIT SERVICES, INC. Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 95287 CHICAGO, IL 60694 | VISION SERVICE PLAN | — | $1K | $1K | 1.73% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 111 W MONROE ST CHICAGO, IL 60603 | HARTFORD LIFE AND ACCIDENT | $4K | — | $4K | 8.88% |
| JOHN D EVANGELISTA | 186 LAS FLORES ALISO VIEJO, CA 92656 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $2K | — | $2K | — |
| MERCER HEALTH AND BENEFITS, LLC Filed as: MERCER HEALTH AND BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $2K | — | $2K | — |
| BRADAWN INSURANCE SERVICES, INC. Filed as: BRADAWN INSURANCE SERVICES INC | 500 LA TERRAZA BLVD ESCONDIDO, CA 92025 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $2K | — | $2K | — |
| TECH COORDINATOR CYBER INSURANCE SO | 10741 LA JARA ST CERRITOS, CA 90703 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $1K | — | $1K | — |
| GALLAGHER BENEFIT SERVICES, INC. Filed as: GALLAGHER BENEFIT SERVICES INC | 500 LA TERRAZA BLVD ESCONDIDO, CA 92025 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $727 | — | $727 | — |
| UZIEL RIVERA | 1267 SILVER TORCH DRIVE BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $319 | — | $319 | — |
| SUSAN GOLD STOKES | 104 MISTY HOLLOW WAY HUNTSVILLE, AL 35806 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $237 | — | $237 | — |
| GOLD RIVER FINANCIAL GROUP LLC | 2807 GRATTON ST RIVERSIDE, CA 92504 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $209 | — | $209 | — |
| LUIS ERNESTO PEREZ Filed as: LUIS PEREZ BENEFIT INSURANCE SOLUTI | 861 KENWOOD ST UPLAND, CA 91784 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $133 | — | $133 | — |
| ALEXANDER OTTONIEL CANAS | 27448 RIVERSIDE LN VALENCIA, CA 91354 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $105 | — | $105 | — |
| RAYMOND KWOCKMAN GONG Filed as: RAYMOND KWOCKMAN GROUP | 1907 COLUMBIA STREET SAN DIEGO, CA 92101 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $105 | — | $105 | — |
| CHAU PHAN | 6 FOREST IRVINE, CA 92612 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $81 | — | $81 | — |
| UNIVERSAL BENEFIT INS AGY | C/O ANNABEL CURTIS SAINT GEORGE, UT 84771 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $70 | — | $70 | — |
| MARIA GONZALEZ | 11677 SANDPIPER CT MORENO VALLEY, CA 92557 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $66 | — | $66 | — |
| ALLIANT INSURANCE SERVICES, INC. Filed as: ALLIANT INSURANCE SERVICES INC | 701 B STREET SAN DIEGO, CA 92101 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $58 | — | $58 | — |
| ASSUREDPARTNERS Filed as: BERTHA PATRICIA SHEPHERD | PO BIX 3216 CRESTLINE, CA 92325 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $32 | — | $32 | — |
| COHR INCORPORATED | 10510 TWIN LAKE PARKWAY CHARLOTTE, NC 28269 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $24 | — | $24 | — |
| ELIZABETH J DOWNEY | 2883 OAKWOOD DR PORT HURON, MI 48060 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $22 | — | $22 | — |
| BLUE PACIFIC INSURANCE SERVICES | 18 SEPULVEDA RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $19 | — | $19 | — |
| MARIA YVONNE RODIGHIERO | 28502 SHRIKE DRIVE LAGUNA NIGUEL, CA 92677 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $13 | — | $13 | — |
| LUIS RAFAEL VALLE | 2354 CHATKA LANE SAN BERNADINO, CA 92410 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $11 | — | $11 | — |
| CONSUMER DRIVEN BENEFITS LLC | 1301 DOVE ST NEWPORT BEACH, CA 92660 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $3 | — | $3 | — |
| MICHAEL C WALKER Filed as: MICHAEL J MINNEY | PO BOX 365 POWAY, CA 92074 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $2 | — | $2 | — |
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 | 803 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 26 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 829 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ROCKY MOUNTAIN HOSPITAL & MEDICAL SERVICE, INC. | 50 | $665K |
| Dental | ROCKY MOUNTAIN HOSPITAL & MEDICAL SERVICE, INC. | 50 | $665K |
| Vision(2 contracts, 2 carriers) | ROCKY MOUNTAIN HOSPITAL & MEDICAL SERVICE, INC. | 610 | $733K |
| Life insurance(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 88 | $41K |
| Short-term disability | COLONIAL LIFE & ACCIDENTAL INSURANCE | 88 | $0 |
| Other | COLONIAL LIFE & ACCIDENTAL INSURANCE | 88 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 610 | — |
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.