| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 323 WEST LAKESIDE AVENUE SUITE 410 CLEVELAND, OH 44113 | ROCKY MOUNTAIN HOSPITAL & MEDICAL SERVICE, INC. | $37K | $523 | $37K | 2.43% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES INC | 1125 SANCTUARY PKWY STE 300 ALPHARETTA, GA 30009 | ROCKY MOUNTAIN HOSPITAL & MEDICAL SERVICE, INC. | $5K | — | $5K | 0.30% |
| BRADAWN INSURANCE SERVICES, INC.3 Filed as: BRADAWN INSURANCE SERVICES INC | 500 LA TERRAZA BLVD STE 102 ESCONDITO, CA 92025 | ROCKY MOUNTAIN HOSPITAL & MEDICAL SERVICE, INC. | — | — | $0 | 0.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 500 LA TERRAZA BLVD ESCONDIDO, CA 92025 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $2K | — | $2K | 2.20% |
| JOHN D EVANGELISTA3 | 186 LAS FLORES ALISO VIEJO, CA 92656 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $2K | $12 | $2K | 2.15% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $2K | — | $2K | 1.74% |
| TECH COORDINATOR CYBER INSURANCE SO3 | 10741 LA JARA ST CERRITOS, CA 90703 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $979 | $4 | $983 | 1.09% |
| UZIEL RIVERA3 | 1267 SILVER TORCH DRIVE BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $262 | — | $262 | 0.29% |
| SUSAN GOLD STOKES3 | 104 MISTY HOLLOW WAY HUNTSVILLE, AL 35806 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $191 | — | $191 | 0.21% |
| GOLD RIVER FINANCIAL GROUP LLC3 | 2807 GRAFTON ST RIVERSIDE, CA 92504 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $169 | — | $169 | 0.19% |
| LUIS ERNESTO PEREZ3 Filed as: LUIS PEREZ BENEFIT INSURANCE SOLUTI | 861 KENWOOD ST UPLAND, CA 91784 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $111 | — | $111 | 0.12% |
| RAYMOND KWOCKMAN GONG3 | 1907 COLUMBIA ST APT 501 SAN DIEGO, CA 92101 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $89 | — | $89 | 0.10% |
| CHAU PHAN3 | 6 FOREST IRVINE, CA 92612 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $62 | — | $62 | 0.07% |
| UNIVERSAL BENEFIT INS AGY3 | CO/ANNABEL CURTIS SAINT GEORGE, UT 84771 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $60 | — | $60 | 0.07% |
| ALEXANDER OTTONIEL CANAS3 | 27448 RIVERSIDE LN VALENCIA, CA 91354 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $60 | — | $60 | 0.07% |
| KRISTIN ANN DECOU3 | 751 ROBIN GLEN RD BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $47 | $3 | $50 | 0.06% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES INC | 701 B STREET SAN DIEGO, CA 92101 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $49 | — | $49 | 0.05% |
| MARIA C GONZALEZ3 | 11677 SANDPIPER CT MORENO VALLEY, CA 92557 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $47 | — | $47 | 0.05% |
| ASSUREDPARTNERS3 Filed as: BERTHA PATRICIA SHEPHERD | PO BOX 3216 CRESTINE, CA 92325 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $27 | — | $27 | 0.03% |
| COHR INCORPORATED3 | 10510 TWIN LAKE PKWY CHARLOTTE, NC 28269 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $26 | — | $26 | 0.03% |
| ELIZABETH J DOWNEY3 | 2883 OAKWOOD DR PORT HURON, MI 48060 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $18 | — | $18 | 0.02% |
| BLUE PACIFIC INSURANCE SERVICES3 | 18 SEPULVEDA RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $16 | — | $16 | 0.02% |
| MARIA YVONNE RODIGHIERO3 | 28502 SHRIKE DRIVE LAGUNA NIGUEL, CA 92577 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $11 | — | $11 | 0.01% |
| LUIS RAFAEL VALLE3 | 2354 CHATKA LN SAN BERNADIDO, CA 92410 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $9 | — | $9 | 0.01% |
| CONSUMER DRIVEN BENEFITS LLC3 | 1301 DOVE ST STE 340 NEWPORT BEACH, CA 92660 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $3 | — | $3 | 0.00% |
| MICHAEL C WALKER3 Filed as: MICHAEL J MINNEY | PO BOX 365 POWAY, CA 92074 | COLONIAL LIFE & ACCIDENTAL INSURANCE | $1 | — | $1 | 0.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 111 W MONROE ST CHICAGO, IL 60603 | HARTFORD LIFE AND ACCIDENT | $6K | — | $6K | 7.93% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SVCS INC | 701 B STREET 6TH FLOOR SAN DIEGO, CA 92101 | HARTFORD LIFE AND ACCIDENT | $2K | — | $2K | 2.07% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 95287 CHICAGO, IL 60694 | HARTFORD LIFE AND ACCIDENT | — | $614 | $614 | 0.82% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 95287 CHICAGO, IL 60694 | VISION SERVICE PLAN | — | $2K | $2K | 2.55% |
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 | 1,092 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,096 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ROCKY MOUNTAIN HOSPITAL & MEDICAL SERVICE, INC. | 123 | $1.5M |
| Dental | ROCKY MOUNTAIN HOSPITAL & MEDICAL SERVICE, INC. | 123 | $1.5M |
| Vision(2 contracts, 2 carriers) | ROCKY MOUNTAIN HOSPITAL & MEDICAL SERVICE, INC. | 662 | $1.6M |
| Life insurance(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENTAL INSURANCE | 224 | $164K |
| Short-term disability | COLONIAL LIFE & ACCIDENTAL INSURANCE | 83 | $90K |
| Other | COLONIAL LIFE & ACCIDENTAL INSURANCE | 83 | $90K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 662 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.