| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES | 80 S. 8TH STREET SUITE 700 MINNEAPOLIS, MN 554022105 | UNITEDHEALTHCARE INSURANCE COMPANY | $43K | — | $43K | 3.30% |
| FBP INSURANCE SERVICES3 Filed as: FBP INSURANCE SERVICES LLC | 130 THEORY SUITE 200 IRVINE, CA 926173065 | UNITEDHEALTHCARE INSURANCE COMPANY | $14K | — | $14K | 1.07% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 18201 VON KARMAN AVENUE SUITE 1020 IRVINE, CA 92612 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $13K | — | $13K | 6.97% |
| FBP INSURANCE SERVICES3 Filed as: FBP INSURANCE SERVICES LLC | 130 THEORY STREET SUITE 200 IRVINE, CA 92660 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 3.18% |
| SUSIE A ESTRADA3 Filed as: SUSIE A. ESTRADA | 25742 PARK AVENUE SAN JUAN CAPISTRANO, CA 92675 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $788 | $127 | $915 | 2.09% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | 2100 ROSS AVE. STE. 1200 DALLAS, TX 75201 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $670 | $31 | $701 | 1.60% |
| G SCOTT COOKE3 Filed as: SCOTT C CASTEEL | 1450 WEST JAMES WAY ANAHEIM, CA 92801 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $614 | — | $614 | 1.40% |
| RALPH F REA JR3 Filed as: RALPH F. REA, JR. | 84 VIA BARCELONA RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $528 | $45 | $573 | 1.31% |
| GREGORY ALFRED MOORE3 | 14 DEODAR IRVINE, CA 92604 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $530 | $4 | $534 | 1.22% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INSURANCE SE | 1920 MAIN ST. IRVINE, CA 92614 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $251 | — | $251 | 0.57% |
| CHARLES D. BLOCK3 Filed as: CHARLES DUANE SMITH | 4040 EAST PIEDMONT DRF HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $161 | — | $161 | 0.37% |
| JOHN D EVANGELISTA3 | 26111 ANTONIO PARKWAY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $122 | $36 | $158 | 0.36% |
| KENNETH D WONG3 | P.O. BOX 11810 MARINA DEL REY, CA 90292 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $132 | — | $132 | 0.30% |
| MARIA LOURDES MENDOZA3 | 26443 SAND PALM CT. MORENO VALLEY, CA 92555 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $80 | — | $80 | 0.18% |
| MIKE MCCORMICK3 | 7 MONSERRAT PL FOOTHILL RANCH, CA 92610 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $63 | — | $63 | 0.14% |
| LUIS RAFAEL VALLE3 | 2354 CHATKA LANE SAN BERNARDINO, CA 92410 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $27 | — | $27 | 0.06% |
| DUSTIN SNYDER3 | 34606 SHALLOT DR. WINCHESTER, CA 92596 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | — | $8 | 0.02% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES | 18201 VON KARMAN AVENUE SUITE 1020 IRVINE, CA 926127171 | VISION SERVICE PLAN | $1K | — | $1K | 4.18% |
| FBP INSURANCE SERVICES3 | 130 THEORY SUITE 200 IRVINE, CA 926173065 | VISION SERVICE PLAN | $197 | — | $197 | 0.75% |
| SUSIE A ESTRADA3 Filed as: SUSIE A. ESTRADA | 25742 PARK AVENUE SAN JUAN CAPISTRANO, CA 92675 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $103 | — | $103 | 2.89% |
| G SCOTT COOKE3 Filed as: SCOTT C. CASTEEL | 1450 WEST JAMES WAY ANAHEIM, CA 92801 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $89 | — | $89 | 2.49% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | 2100 ROSS AVENUE SUITE 1200 DALLAS, TX 75201 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $79 | — | $79 | 2.21% |
| RALPH F REA JR3 Filed as: RALPH F. REA JR. | 84 VIA BARCELONA RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $64 | $10 | $74 | 2.07% |
| GREGORY ALFRED MOORE3 | 14 DEODAR IRVINE, CA 92604 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $34 | $21 | $55 | 1.54% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INSURANCE SV | 1920 MAIN STREET IRVINE, CA 92614 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $46 | — | $46 | 1.29% |
| CHARLES D. BLOCK3 Filed as: CHARLES DUANE SMITH | 4040 EAST PIEDMONT DR. HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $29 | — | $29 | 0.81% |
| KENNETH D WONG3 Filed as: KENNETH D. WONG | P. O. BOX 11810 MARINA DEL REY, CA 90292 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $24 | — | $24 | 0.67% |
| JOHN D EVANGELISTA3 Filed as: JOHN D. EVANGELISTA | 26111 ANTONIO PARKWAY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16 | $3 | $19 | 0.53% |
| MARIA LOURDES MENDOZA3 | 26443 SAND PALM COURT MORENO VALLEY, CA 92555 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $17 | — | $17 | 0.48% |
| MIKE MCCORMICK3 | 7 MONSERRAT PLACE FOOTHILL RANCH, CA 92610 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $11 | — | $11 | 0.31% |
| LUIS RAFAEL VALLE3 | 2354 CHATKA LANE SAN BERNARDINO, CA 92410 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | — | $10 | 0.28% |
| DUSTIN SNYDER3 | 34606 SHALLOT DRIVE WINCHESTER, CA 92596 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.06% |
| PACIFIC BAY INSURANCE GROUP INC3 Filed as: PACIFIC BAY INSURANCE GROUP INC. | 18301 VON KARMAN AVENUE IRVINE, CA 92612 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.03% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 SOUTH 8TH STREET SUITE 700 MINNEAPOLIS, MN 55402 | HOLMAN FAMILY COUNSELING, INC. | $221 | — | $221 | 6.95% |
| FBP INSURANCE SERVICES3 | 130 THEORY SUITE 200 IRVINE, CA 926173065 | VISION SERVICE PLAN | $163 | — | $163 | 9.99% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 SOUTH 8TH STREET SUITE 700 MINNEAPOLIS, MN 55402 | HOLMAN FAMILY COUNSELING, INC. | $19 | — | $19 | 7.06% |
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 | 118 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 20 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 139 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | UNITEDHEALTHCARE INSURANCE COMPANY | 130 | $1.4M |
| Dental(2 contracts) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 171 | $180K |
| Vision(2 contracts) | VISION SERVICE PLAN | 145 | $28K |
| Life insurance(2 contracts) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 171 | $180K |
| Short-term disability(4 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 171 | $227K |
| Long-term disability(2 contracts) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 171 | $180K |
| Other(6 contracts, 3 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 171 | $230K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 171 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.