| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 SOUTH 8TH STREET STE. 700 MINNEAPOLIS, MN 55402 | CALIFORNIA PHYSICIANS' SERVICE | $55K | — | $55K | 4.00% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 SOUTH 8TH STREET SUITE 700 MINNEAPOLIS, MN 55402 | UNITED CONCORDIA INSURANCE COMPANY | $5K | — | $5K | 7.37% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 SOUTH 8TH STREET SUITE 700 MINNEAPOLIS, MN 55402 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $8K | — | $8K | 15.67% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $50 | $50 | 0.10% |
| SUSIE A ESTRADA3 Filed as: SUSIE A. ESTRADA | 25742 PARK AVENUE SAN JUAN CAPISTRANO, CA 92675 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $873 | $198 | $1K | 2.26% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | 2100 ROSS AVE. STE. 1200 DALLAS, TX 75201 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $764 | $97 | $861 | 1.82% |
| G SCOTT COOKE3 Filed as: SCOTT C CASTEEL | 1450 WEST JAMES WAY ANAHEIM, CA 92801 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $710 | — | $710 | 1.50% |
| RALPH F REA JR3 Filed as: RALPH F. REA, JR. | 84 VIA BARCELONA RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $575 | — | $575 | 1.21% |
| GREGORY ALFRED MOORE3 | 14 DEODAR IRVINE, CA 92604 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $406 | $30 | $436 | 0.92% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INSURANCE SE | 1920 MAIN ST. IRVINE, CA 92614 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $314 | — | $314 | 0.66% |
| CHARLES D. BLOCK3 Filed as: CHARLES DUANE SMITH | 4040 EAST PIEDMONT DRF HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $207 | — | $207 | 0.44% |
| MARIA LOURDES MENDOZA3 | 26443 SAND PALM CT. MORENO VALLEY, CA 92555 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $181 | $12 | $193 | 0.41% |
| JOHN D EVANGELISTA3 | 26111 ANTONIO PARKWAY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $136 | $42 | $178 | 0.38% |
| KENNETH D WONG3 | P.O. BOX 11810 MARINA DEL REY, CA 90292 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $145 | — | $145 | 0.31% |
| LUIS RAFAEL VALLE3 | 2354 CHATKA LANE SAN BERNARDINO, CA 92410 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $106 | — | $106 | 0.22% |
| MIKE MCCORMICK3 | 7 MONSERRAT PL FOOTHILL RANCH, CA 92610 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $79 | — | $79 | 0.17% |
| WILLIAM ROGER CORRIN3 | 677 ULTIMO AVENUE LONG BEACH, CA 90814 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $21 | — | $21 | 0.04% |
| DUSTIN SNYDER3 | 34606 SHALLOT DR. WINCHESTER, CA 92596 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | — | $9 | 0.02% |
| PACIFIC BAY INSURANCE GROUP INC3 | 18301 VON KARMAN AVE. IRVINE, CA 92612 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | — | $7 | 0.01% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 SOUTH 8TH STREET SUITE 700 MINNEAPOLIS, MN 55402 | UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. | $3K | — | $3K | 7.35% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 SOUTH 8TH STREET SUITE 700 MINNEAPOLIS, MN 55402 | VISION SERVICE PLAN | $1K | — | $1K | 5.07% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 SOUTH 8TH STREET SUITE 700 MINNEAPOLIS, MN 55402 | GUARDIAN | $754 | — | $754 | 13.00% |
| PACIFIC ADVISORS LLC3 Filed as: PACIFIC ADVISORS, INC. | 1550 W. COLORADO BLVD. PASADENA, CA 91105 | GUARDIAN | $15 | — | $15 | 0.26% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 SOUTH 8TH STREET SUITE 700 MINNEAPOLIS, MN 55402 | HOLMAN FAMILY COUNSELING, INC. | $213 | — | $213 | 5.00% |
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 | 161 | 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) | 161 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA PHYSICIANS' SERVICE | 271 | $1.4M |
| Dental(2 contracts, 2 carriers) | UNITED CONCORDIA INSURANCE COMPANY | 184 | $99K |
| Vision | VISION SERVICE PLAN | 135 | $24K |
| Life insurance(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 161 | $55K |
| Short-term disability(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 161 | $96K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 161 | $49K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 271 | $1.4M |
| Other(4 contracts, 4 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 161 | $106K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 271 | — |
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.