| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BENEFIT PRO INSURANCE SERVICES, INC3 Filed as: BENEFIT PRO INS SERVICES INC | 2655 CAMINO DEL RIO NORTH SUITE 425 SAN DIEGO, CA 92108 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | — | $4K | 3.52% |
| MELISSA D CARRILLO3 | 9469 FAIRGROVE LN SAN DIEGO, CA 92129 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $635 | $4K | 3.28% |
| RAYMOND KWOCKMAN GONG3 Filed as: RAYMOND GONG | 2180 FENTON PARKWAY SAN DIEGO, CA 92108 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $550 | $4K | 3.06% |
| ANDREA MARIE TIERCE3 | 2204 PLEASANTWOOD LN ESCONDIDO, CA 92026 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $666 | $2K | 1.48% |
| GEORGE MICHAEL SORRENTINO3 | 1123 ALEXANDRIA DRIVE SAN DIEGO, CA 92107 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 1.29% |
| KINGHORN & ASSOCIATES3 | PO BOX 225 BONITA, CA 91908 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 0.89% |
| KJM MANAGEMENT LLC3 | 4459 CLAIREMONT DRIVE UNIT B SAN DIEGO, CA 92117 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $884 | $144 | $1K | 0.86% |
| MARGARITA ALEJANDRA RAMIREZ3 | 1356 CALLE COLNETT SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $553 | $230 | $783 | 0.65% |
| CHRISTINA D POLK INC3 | 9755 QUENCIA CT LAS VEGAS, NV 89149 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $600 | — | $600 | 0.50% |
| BELLA NATION BENEFITS LLC3 | 8693 TARA HILL AVE LAS VEGAS, NV 89148 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $544 | $15 | $559 | 0.47% |
| G SCOTT COOKE3 Filed as: SCOTT C CASTEEL | 1450 WEST JAMES WAY ANAHEIM, CA 92801 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $533 | — | $533 | 0.44% |
| CLIENT BENEFIT INSURANCE SERVICES3 | 5675 RUFFIN ROAD SAN DIEGO, CA 92123 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $321 | $103 | $424 | 0.35% |
| MICHAEL C WALKER3 Filed as: MICHAEL J MINNEY | PO BOX 365 POWAY, CA 92074 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $346 | $77 | $423 | 0.35% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | PO BOX 6030 PASADENA, CA 911026030 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $420 | — | $420 | 0.35% |
| SUSIE A ESTRADA3 | 25742 PARK AVENUE SAN JUAN CAPISTRANO, CA 92675 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $396 | — | $396 | 0.33% |
| CALIFORNIA INSURANCE ADVOCATES INC3 | 41960 AVENIDA DE ANITA TEMECULA, CA 92592 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $286 | $100 | $386 | 0.32% |
| COUNT ON WELLNESS3 | 3306 MORAGA PLACE SAN DIEGO, CA 92117 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $380 | — | $380 | 0.32% |
| WILLIAM L WISER3 | 12725 JARDIN RD SAN DIEGO, CA 92128 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $229 | $15 | $244 | 0.20% |
| LISA ANN DIMON3 | C/O LISA DIMON SACRAMENTO, CA 95834 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $233 | — | $233 | 0.19% |
| SAMAR BREIK ALBIN3 | 41572 VALOR DR MURRIETA, CA 92562 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $169 | $20 | $189 | 0.16% |
| CHARLES D. BLOCK3 Filed as: CHARLES DUANE SMITH | 4040 EAST PIEDMONT DR HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $153 | — | $153 | 0.13% |
| RALPH F REA JR3 | 84 VIA BARCELONA RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $115 | — | $115 | 0.10% |
| GROUP SUPPLEMENTAL BENEFITS INC3 | 31805 TEMECULA PARKWAY TEMECULA, CA 92592 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $102 | — | $102 | 0.08% |
| WENDY DAWN PACK3 | 16109 WATT WAY RAMONA, CA 92065 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $88 | $4 | $92 | 0.08% |
| ABRAMS MARKETING INC3 | 9538 W PICO BLVD LOS ANGELES, CA 90035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $76 | — | $76 | 0.06% |
| ISIDORO ZEICHNER3 | 525 C ST APT 425 SAN DIEGO, CA 92101 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $50 | $12 | $62 | 0.05% |
| MIKE MCCORMICK3 | 7 MONSERRAT PLACE FOOTHILL RANCH, CA 92610 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $57 | — | $57 | 0.05% |
| PACIFIC BAY INSURANCE GROUP INC3 | 18301 VON KARMAN AVE IRVINE, CA 92612 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $47 | — | $47 | 0.04% |
| LORI LAINE3 | 35837 CARTER ST YUCAIPA, CA 92399 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $25 | $7 | $32 | 0.03% |
| ROGER STUART KENCHEL3 | 2588 EL CAMINO REAL CARLSBAD, CA 92008 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $31 | — | $31 | 0.03% |
| TMS INSURANCE LLC3 Filed as: TMS BENEFITS INC | 1002 SUMMIT TRAIL ESCONDIDO, CA 92025 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $30 | — | $30 | 0.02% |
| JAKORP INC3 | PO BOX 27207 SAN DIEGO, CA 92192 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $28 | — | $28 | 0.02% |
| OMEGA FINANCIAL AND INSURANCE SOLUT3 Filed as: OMEGA FINANCIAL AND INSUR SOLUTIONS | 4663 CREEPING FIT CT LAS VEGAS, NV 89129 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | $7 | $14 | 0.01% |
| COURTNEY MCFARLAND3 | 852 BAYWOOD DR NEWPORT BEACH, CA 92660 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | — | $8 | 0.01% |
| JIM BARRETT3 | 8514 EAST KRAIL ST SCOTTSDALE, AZ 85250 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.00% |
| CHELSEA LYNNE WARE3 | 12692 ELISA LANE UNIT 226 SAN DIEGO, CA 92128 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| BENEFIT PRO INSURANCE SERVICES, INC3 Filed as: BENEFIT PRO INS SERVICES INC | 2655 CAMINO DEL RIO NORTH STE 425 SAN DIEGO, CA 92108 | UNION SECURITY INSURANCE COMPANY | $7K | — | $7K | 5.85% |
| BENEFIT PRO INSURANCE SERVICES, INC3 Filed as: BENEFIT PRO INS SERVICES INC | 2655 CAMINO DEL RIO NORTH STE 425 SAN DIEGO, CA 92108 | UDC DENTAL OF CALIFORNIA INC | $2K | — | $2K | 10.02% |
| BENEFIT PRO INSURANCE SERVICES, INC3 Filed as: BENEFIT PRO INS SERVICES INC | 2655 CAMINO DEL RIO NORTH SUITE 425 SAN DIEGO, CA 92108 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $2K | — | $2K | 9.23% |
| BRANDEN R SAMANIEGO4 | 31860 RUTH LN HOMELAND, CA 92548 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $3K | — | $3K | 23.65% |
| DAVID QUACKENBUSH4 | 5353 SOUTH GENOA WAY CENTENNIAL, CO 80015 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $2K | — | $2K | 11.90% |
| ANNETTE E WHITE INS SERVICES INC4 Filed as: ANNETTE E WHITE INSURANCE SERVICES | 10755 SCRIPPS POWAY PKWY 454 SAN DIEGO, CA 92131 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $31 | — | $31 | 0.24% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EBA&M CORPORATION EIN 95-2881702 PLAN ADMINISTRATOR | Plan Administrator Service code 14 | — | $66K |
| FIRST HEALTH GROUP CORPORATION EIN 20-1736437 PPO-PREF PROV NETWORK | Insurance services Service code 23 | 23291 NETWORK PLACE CHICAGO, IL 606731233 | $89 |
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 | 0 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(2 contracts, 2 carriers) | UNION SECURITY INSURANCE COMPANY | 273 | $135K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 289 | $20K |
| Life insurance(3 contracts, 3 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 387 | $255K |
| Stop-loss / reinsurancereinsurance | AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXAS | 387 | $280K |
| Other | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | 70 | $13K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 387 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.