| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HEALTHY HALO INSURANCE SERVICES INC3 | 110 W PROVIDENCIA AVE SUITE 101 BURBANK, CA 91502 | CALIFORNIA PHYSICIANS SERVICE | $0 | $105K | $105K | 5.27% |
| HEALTHY HALO INSURANCE SERVICES INC3 | 2601 LARMAR RD LOS ANGELES, CA 90068 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $0 | $4K | 6.43% |
| MCCAREY INC3 Filed as: MCCAREY INC. | 6320 GREENHAVEN DR CARLSBAD, CA 92009 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $167 | $2K | 3.68% |
| ANDREA MARIE TIERCE3 | 2204 PLEASANTWOOD LANE ESCONDIDO, CA 92026 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $532 | $37 | $569 | 0.91% |
| DANA MARIE MOWATT3 | 23701 S WESTERN AVENUE #112 TORRANCE, CA 90501 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $526 | $31 | $557 | 0.90% |
| DEL DOWNEY3 | 32056 MERLOT CRST TEMECULA, CA 92591 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $392 | $0 | $392 | 0.63% |
| MAGNONE FINANCIAL SERVICES CORP3 | 3151 OUTRIGGER AVE VENTURA, CA 93001 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $170 | $0 | $170 | 0.27% |
| R & B ENROLLMENT SERVICES INC3 Filed as: R & B ENROLLMENT SERVICES, INC. | PO BOX 3216 CRESTLINE, CA 92325 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $158 | $0 | $158 | 0.25% |
| ELTHON ISRAEL CRUZ3 | 893 SOUTH 2100 WEST OREN, UT 84059 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $118 | $0 | $118 | 0.19% |
| UZIEL RIVERA3 | 1267 SILVER TORCH DRIVE BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $26 | $0 | $26 | 0.04% |
| DEBRA JEAN HUMPHREY3 | 1325 MARDI LN HOUSTON, TX 77055 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $24 | $0 | $24 | 0.04% |
| LIFE TIME SOLUTIONS LLC3 | 861 KENWOOD STREET UPLAND, CA 91784 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $22 | $0 | $22 | 0.04% |
| MARIA VERONICA JARQUE3 | 4525 GEORGIA ST SAN DIEGO, CA 82116 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $21 | $0 | $21 | 0.03% |
| BARBARA ANN BASTON3 | 5401 MANSEL LANE FT WORTH, TX 76134 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $19 | $0 | $19 | 0.03% |
| DONALD C SAVOY INC3 Filed as: DONALD TERRY GOTHAM | 3129 ECLIPSE DR. GREEN BAY, WI 54311 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16 | $0 | $16 | 0.03% |
| JUDY INEZ BUCHOLTZ3 Filed as: JUDY I BUCHHOLTZ | 12517 217TH AVE CT E BONNEY LAKE, WA 98391 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $15 | $0 | $15 | 0.02% |
| LUIS ERNESTO PEREZ3 Filed as: LUIS PEREZ BENEFIT INSURANCE | 861 KENWOOD STREET UPLAND, CA 91784 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $14 | $0 | $14 | 0.02% |
| WENDY DAWN PACK3 Filed as: WENDY GERSHOW | 3217 STAR AVE OAKLAND, CA 94619 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $13 | $0 | $13 | 0.02% |
| JANICE D RUCKS3 | 1204 CHAMBERLAIN NO. 4 MEMPHIS, TN 38119 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | $0 | $2 | 0.00% |
| MICHAEL JAMES LEBRANE3 | 808 EAST 5TH AVE SAN MATEO, CA 94402 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | $0 | $1 | 0.00% |
| HEALTHY HALO INSURANCE SERVICES INC3 | 110 W PROVIDENCIA AVE SUITE 101 BURBANK, CA 91502 | VISION SERVICE PLAN | $525 | $0 | $525 | 3.19% |
| HEALTHY HALO INSURANCE SERVICES INC3 | 110 W PROVIDENCIA AVE SUITE 101 BURBANK, CA 91502 | SUN LIFE ASSURANCE COMPANY OF CANADA | $700 | $0 | $700 | 7.50% |
| MCCAREY INC3 Filed as: MCCAREY INC. DBA ESSENTIAL BENEFITS | 6320 GREENHAVEN DR CARLSBAD, CA 92009 | SUN LIFE ASSURANCE COMPANY OF CANADA | $700 | $0 | $700 | 7.50% |
| HEALTHY HALO INSURANCE SERVICES INC3 | 110 W PROVIDENCIA AVE SUITE 101 BURBANK, CA 91502 | BLUE SHIELD OF CALIFORNIA LIFE & HEALTH INSURANCE COMPANY | $697 | $0 | $697 | 10.00% |
| HEALTHY HALO INSURANCE SERVICES INC3 | 515 S. FLOWER ST., 36TH FLOOR LOS ANGELES, CA 90071 | DELTA DENTAL OF CALIFORNIA | $711 | $0 | $711 | 10.46% |
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 | 141 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 19 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 160 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA PHYSICIANS SERVICE | 213 | $2.0M |
| Dental | DELTA DENTAL OF CALIFORNIA | 35 | $7K |
| Vision | VISION SERVICE PLAN | 103 | $16K |
| Life insurance(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 138 | $69K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 15 | $9K |
| Prescription drug | CALIFORNIA PHYSICIANS SERVICE | 213 | $2.0M |
| Other(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 138 | $69K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 213 | — |
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.