| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | PO BOX 39000 SAN FRANCISCO, CA 94139 | UNITED HEALTHCARE INSURANCE COMPANY | $43K | — | $43K | 5.27% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 21250 HAWTHORNE BOULEVARD TORRANCE, CA 90503 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 9.68% |
| JOHN D EVANGELISTA3 Filed as: JOHN D. EVANGELISTA | 26111 ANTONIO PARKWAY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $753 | $78 | $831 | 3.45% |
| UZIEL RIVERA6 | 543 CHEROKEE CIRCLE BANNING, CA 92220 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $321 | $75 | $396 | 1.64% |
| MJ INSURANCE3 Filed as: CALVIN D. INGLE AND VARIOUS AGENTS | 1840 LARIAT TRAIL CELINA, TX 75009 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $345 | $8 | $353 | 1.46% |
| ADRIANA MENDIETA3 | 29448 TOURS STREET LAKE ELSINORE, CA 92530 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $265 | $31 | $296 | 1.23% |
| SARAH COURTNEY KNAPP3 | 61 SKLAR LADERA RANCH, CA 92694 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $115 | $51 | $166 | 0.69% |
| SUSAN GOLD STOKES3 Filed as: SUSAN G. STOKES | 3113 WEST 187TH PLACE TORRANCE, CA 90504 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $127 | — | $127 | 0.53% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | PO BOX 203334 DALLAS, TX 75320 | UNIMERICA LIFE INSURANCE SERVICES | $700 | — | $700 | 9.87% |
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 | 191 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 191 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED HEALTHCARE INSURANCE COMPANY | 197 | $823K |
| Dental | UNITED HEALTHCARE INSURANCE COMPANY | 197 | $823K |
| Vision | UNITED HEALTHCARE INSURANCE COMPANY | 197 | $823K |
| Life insurance(2 contracts, 2 carriers) | UNITED HEALTHCARE INSURANCE COMPANY | 197 | $830K |
| Prescription drug | UNITED HEALTHCARE INSURANCE COMPANY | 197 | $823K |
| Other(3 contracts, 3 carriers) | UNITED HEALTHCARE INSURANCE COMPANY | 197 | $855K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 197 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
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.