| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 SO. 8TH ST., STE. 700 MINNEAPOLIS, MN 55402 | CALIFORNIA PHYSICIAN'S SERVICE | $46K | $67 | $46K | 3.00% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 SO. 8TH ST., STE. 700 MINNEAPOLIS, MN 55402 | DENTAL HEALTH SERVICES | $10K | — | $10K | 8.81% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 SO. 8TH ST., STE. 700 MINNEAPOLIS, MN 55402 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | $1K | $9K | 12.03% |
| TIFFANY ANN KING3 | 3850 VINE STREET SUITE 130 RIVERSIDE, CA 92507 | AFLAC | $4K | $362 | $5K | 6.95% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 SO. 8TH ST., STE. 700 MINNEAPOLIS, MN 55402 | AFLAC | $3K | — | $3K | 4.25% |
| DOUGLAS J SUCHECKI3 | 3850 VINE STREET SUITE 130 RIVERSIDE, CA 92507 | AFLAC | $1K | $123 | $2K | 2.31% |
| JULIUS ROBERT BOTELHO3 | PO BOX 7814 REDLANDS, CA 92375 | AFLAC | $824 | — | $824 | 1.24% |
| DAWN T SUCHECKI3 | 3850 VINE STREET SUITE 130 RIVERSIDE, CA 92507 | AFLAC | $725 | $73 | $798 | 1.20% |
| MARIO H PINZON3 | 4630 SAN JOSE ST APT C MONTCLAIR, CA 91763 | AFLAC | $474 | — | $474 | 0.71% |
| KATHLEEN LEININGER INS SERVICES INC3 | 8880 BENSON AVE STE 106 MONTCLAIR, CA 91763 | AFLAC | $299 | — | $299 | 0.45% |
| DIANNE SEMINARIS INC3 | 833 W RAE CT UPLAND, CA 91784 | AFLAC | $295 | — | $295 | 0.44% |
| ANDREW R GRETHEL3 | 5963 LA PLACE COURT SUITE 107 CARLSBAD, CA 92008 | AFLAC | $178 | $102 | $280 | 0.42% |
| FIRST LINE INS SERVICES3 | 1200 CALIFORNIA ST #260 REDLANDS, CA 92374 | AFLAC | $267 | — | $267 | 0.40% |
| JEFFREY T JOHNSON3 | 15590 SYRACUSE LN FONTANA, CA 92336 | AFLAC | $252 | — | $252 | 0.38% |
| TERRANCE M LUCZAJ3 | 1201 MAIN ST STE 2300 COLUMBIA, SC 29201 | AFLAC | $225 | — | $225 | 0.34% |
| CHRISTOPHER H APFEL3 | 14624 EL CENTRO ST HESPERIA, CA 92345 | AFLAC | $198 | — | $198 | 0.30% |
| NANCY L BOTELHO3 | PO BOX 7814 REDLANDS, CA 92375 | AFLAC | $181 | — | $181 | 0.27% |
| JAMES P BOADA3 | 30 STONEY PT LAGUNA NIGUEL, CA 92677 | AFLAC | $152 | — | $152 | 0.23% |
| DANIEL MARTIN BREDESON3 | 641 HIGUERA ST SUITE 300 SAN LUIS OBISPO, CA 93401 | AFLAC | $100 | — | $100 | 0.15% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF ARIZONA INC | 16220 N SCOTTSDALE RD STE 600 SCOTTSDALE, AZ 85254 | AFLAC | $90 | — | $90 | 0.14% |
| JAMES M PITZ3 Filed as: JAMES R LANDINGHAM | 28750 LEXINGTON RD TEMECULA, CA 92591 | AFLAC | $63 | $23 | $86 | 0.13% |
| DEBRA J SUMPTER3 | PO BOX 9081 SAN BERNARDINO, CA 92427 | AFLAC | $85 | — | $85 | 0.13% |
| ARROWHEAD FINANCIAL GROUP INC3 | 550 E HOSPITALITY LANE SUITE 100 SAN BERNARDINO, CA 92408 | AFLAC | $80 | — | $80 | 0.12% |
| MARY NANTKER3 | 164 E 6TH ST NATALIA, TX 78059 | AFLAC | $73 | — | $73 | 0.11% |
| JUDITH LYNN YAMAMOTO3 | PO BOX 9054 REDLANDS, CA 92375 | AFLAC | $57 | — | $57 | 0.09% |
| VALERIE LOGAN3 | 11093 RAYMOND RD MORENO VALLEY, CA 92555 | AFLAC | $46 | — | $46 | 0.07% |
| GARY W WARE JR3 | 2306 VALLEYBROOK DR CHAMPAIGN, IL 61822 | AFLAC | $30 | — | $30 | 0.05% |
| GOODWIN INSURANCE AGENCY INC3 | PO BOX 1897 REDLANDS, CA 92373 | AFLAC | $29 | — | $29 | 0.04% |
| SHANE M OWEN3 Filed as: SHANE CRAIG DAVISON | 1300 SHETTER AVE APT 4202 JACKSONVILLE BEACH, FL 32250 | AFLAC | $28 | — | $28 | 0.04% |
| SANDRA MARIE FRY3 | 1355 LAURA CT TEMPLETON, CA 93465 | AFLAC | $23 | — | $23 | 0.03% |
| JOSE BECERRA3 | 205 W CARLTON ST ONTARIO, CA 91762 | AFLAC | $19 | — | $19 | 0.03% |
| MARVIN L FORTMAN3 | 1044 GREENWAY CT ALTOONA, IA 50009 | AFLAC | $17 | — | $17 | 0.03% |
| THOMAS S GENTZ3 | 3848 CHERRY BROOK LN MASON, OH 45040 | AFLAC | $12 | — | $12 | 0.02% |
| DIANE R SIPE3 | 7030 E CREEK SIDE LN ANAHEIM, CA 92807 | AFLAC | $6 | — | $6 | 0.01% |
| SCOTT W BLACKSHEAR3 | 3453 CATHRYN DR COLUMBUS, GA 31906 | AFLAC | $4 | — | $4 | 0.01% |
| CYNTHIA LEE MACK MILLER3 | 3015 SHADID DR COLTON, CA 92324 | AFLAC | $4 | — | $4 | 0.01% |
| LEILANI FOLLENS-JONES3 Filed as: LEILANI MARIE FOLLEN-JONES | 5187 ASPEN DR MONTCLAIR, CA 91763 | AFLAC | $4 | — | $4 | 0.01% |
| JOSEPH H FERRELL3 | 709 WEST FERN AV REDLANDS, CA 92373 | AFLAC | $3 | — | $3 | 0.00% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 SO. 8TH ST., STE. 700 MINNEAPOLIS, MN 55402 | EYEMED VISION CARE | $4K | — | $4K | 10.71% |
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 | 300 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 302 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIAN'S SERVICE | 344 | $1.6M |
| Dental | DENTAL HEALTH SERVICES | 231 | $110K |
| Vision | EYEMED VISION CARE | 408 | $33K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 236 | $73K |
| Short-term disability(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 236 | $140K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 236 | $73K |
| Prescription drug | CALIFORNIA PHYSICIAN'S SERVICE | 344 | $1.5M |
| Other(3 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 300 | $147K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 408 | — |
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.