| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 Filed as: BENFIT PRO INS SERVICES INC | 2655 CAMINO DEL RIO NORTH SUITE 425 SAN DIEGO, CA 92108 | UNION SECURITY INSURANCE COMPANY | $9K | — | $9K | 5.52% |
| RAYMOND KWOCKMAN GONG3 | 2180 FENTON PARKWAY SAN DIEGO, CA 92108 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $779 | $4K | 3.37% |
| MELISSA D CARRILLO3 | 9469 FAIRGROVE LANE SAN DIEGO, CA 92129 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $909 | $4K | 3.19% |
| BENEFIT PRO INSURANCE SERVICES, INC3 Filed as: BENEFIT PRO INSURANCE SERVICES INC | 2655 CAMINO DEL RIO NORTH SAN DIEGO, CA 92108 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | — | $3K | 2.76% |
| ANDREA MARIE TIERCE3 | 2204 PLEASANTWOOD LANE ESCONDIDO, CA 92026 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $551 | $2K | 1.31% |
| GEORGE MICHAEL SORRENTINO3 | 1123 ALEXANDRIA DR SAN DIEGO, CA 92107 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 0.82% |
| KINGHORN & ASSOCIATES3 Filed as: KINGHORN & ASSOCIATES INS & FIN | PO BOX 225 BONITA, CA 91908 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $969 | — | $969 | 0.77% |
| G SCOTT COOKE3 Filed as: SCOTT C CASTEEL | 1450 WEST JAMES WAY ANAHEIM, CA 92801 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $506 | — | $506 | 0.40% |
| CLIENT BENEFIT INSURANCE SERVICES3 | 5675 RUFFIN ROAD SAN DIEGO, CA 92123 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $459 | $41 | $500 | 0.40% |
| MICHAEL C WALKER3 Filed as: MICHAEL J MINNEY | PO BOX 365 POWAY, CA 92074 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $374 | $121 | $495 | 0.39% |
| BELLA NATION BENEFITS LLC3 Filed as: BELLA NATION BENEFITS INC | 8693 TARA HILL AVE LAS VEGAS, NV 89148 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $392 | — | $392 | 0.31% |
| CHRISTINA D POLK INC3 | 9755 QUENCIA CT LAS VEGAS, NV 89149 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $383 | — | $383 | 0.30% |
| SUSIE A ESTRADA3 | 25742 PARK AVENUE SAN JUAN CAPISTRANO, CA 92675 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $376 | — | $376 | 0.30% |
| ANTONIA MARIE HOLDEN3 | 8932 CREEKFORD ST LAKESIDE, CA 92040 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $317 | $38 | $355 | 0.28% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY INSURANCE BROKERS | PO BOX 6030 PASADENA, CA 91102 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $298 | — | $298 | 0.24% |
| LISA ANN DIMON3 | C/O LISA DIMON GRASS VALLEY, CA 95945 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $224 | — | $224 | 0.18% |
| KJM MANAGEMENT LLC3 | 4459 CLAIRMONT DRIVE UNIT B SAN DIEGO, CA 92117 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $162 | $2 | $164 | 0.13% |
| CHARLES D. BLOCK3 Filed as: CHARLES DUANE SMITH | 4040 EAST PIEDMONT DR HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $135 | — | $135 | 0.11% |
| CALIFORNIA INSURANCE ADVOCATES INC3 | 41960 AVENIDA DE ANITA TEMECULA, CA 92592 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $102 | $27 | $129 | 0.10% |
| MARGARITA ALEJANDRA RAMIREZ3 | 1356 CALLE COLNETT SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $105 | $20 | $125 | 0.10% |
| RALPH F REA JR3 | 84 VIA BARCELONA RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $115 | — | $115 | 0.09% |
| JOSEPH RUBINO3 | 1806 BRABHAM ST EL CAJON, CA 92019 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $112 | $3 | $115 | 0.09% |
| GROUP SUPPLEMENTAL BENEFITS INC3 | 31805 TEMECULA PARKWAY TEMECULA, CA 92592 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $96 | — | $96 | 0.08% |
| SAMAR BREIK ALBIN3 | 41572 VALOR DR MURRIETA, CA 92562 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $92 | — | $92 | 0.07% |
| DEL DOWNEY3 | 41960 AVENIDA DE ANITA TEMECULA, CA 92592 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $75 | $2 | $77 | 0.06% |
| CARLEE SHERMAN3 | 908 GENTER STREET LA JOLLA, CA 92037 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $46 | $9 | $55 | 0.04% |
| MIKE MCCORMICK3 | 7 MONSERRAT PL FOOTHILL RANCH, CA 92610 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $53 | — | $53 | 0.04% |
| WENDY DAWN PACK3 | 16109 WATT WAY RAMONA, CA 92065 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $52 | — | $52 | 0.04% |
| ABRAMS MARKETING INC3 | 9538 W PICO BLVD LOS ANGELS, CA 90035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $47 | — | $47 | 0.04% |
| WILLIAM L WISER3 | 12725 JARDIN RD SAN DIEGO, CA 92128 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $41 | — | $41 | 0.03% |
| COUNT ON WELLNESS3 | 3306 MORAGA PLACE SAN DIEGO, CA 92117 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $25 | — | $25 | 0.02% |
| JENNIFER AURORA RAMIREZ3 | 1053 FICUS LANE SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $23 | $2 | $25 | 0.02% |
| ROBERT C WAITE3 Filed as: ROBERT STUART KENCHEL | 2588 EL CAMINO REAL CARLSBAD, CA 92008 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $13 | — | $13 | 0.01% |
| COURTNEY MCFARLAND3 | 852 BAYWOOD DR NEWPORT BEACH, CA 92660 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | — | $8 | 0.01% |
| TIM CHRISTOPHER ELLIS3 | PO BOX 483 ORANGE, CA 92856 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | $1 | $3 | 0.00% |
| MICHAEL F FAHEY III3 | 411 AVENIDA ADOBE SAN CLEMENTE, CA 92672 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.00% |
| JAKORP INC3 | PO BOX 27207 SAN DIEGO, CA 92108 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.00% |
| JIM BARRETT3 | 8514 EAST KRAIL ST SCOTTSDALE, AZ 85250 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.00% |
| CHELSEA L WARE LLC3 | 9755 QUENCIA CT LAS VEGAS, NV 89149 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| MELISSA D CARRILLO3 | 9469 FAIRGROVE LN SAN DIEGO, CA 92129 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | — | — | $0 | 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 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $2K | — | $2K | 9.19% |
| BRANDEN R SAMANIEGO4 | 31860 RUTH LN HOMELAND, CA 92548 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $2K | — | $2K | 19.15% |
| DAVID QUACKENBUSH4 | 5353 SOUTH GENOA WAY CENTENNIAL, CO 80015 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $1K | — | $1K | 10.93% |
| ANNETTE E WHITE INS SERVICES INC4 | 10755 SCRIPPS POWAY PARKWAY SAN DIEGO, CA 92131 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $31 | — | $31 | 0.25% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EBA&M CORPORATION EIN 95-2881702 PLAN ADMINISTRATOR | Plan Administrator Service code 14 | 18002 COWAN IRVINE, CA 92614 | $66K |
| BLUE CROSS LIFE & HEALTH EIN 95-4331852 CLAIMS PROCESSING | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing; Other services Service code 12 | 21555 OXNARD WOODLAND HILLS, CA 91367 | $55K |
| BENEFIT PRO INSURANCE SERVICES EIN 33-0971760 BENEFIT SERVICES | Insurance agents and brokers Service code 22 | 2655 CAMINO DEL RIO NORTH SUITE 425 SAN DIEGO, CA 92108 | $39K |
| TC3 HEALTH INC EIN 13-4346850 BENEFITS REVIEW | Consulting (general) Service code 16 | 19732 MACURTHUR BLVD 100 IRVINE, CA 92612 | $3K |
| FIRST HEALTH GROUP CORPORATION EIN 20-1736437 PPO-PREF PROV NETWORK | Insurance services Service code 23 | 23291 NETWORK PLACE CHICAGO, IL 606731233 | $91 |
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 | 458 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 458 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | UNION SECURITY INSURANCE COMPANY | 279 | $160K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 0 | $21K |
| Life insurance(2 contracts, 2 carriers) | UNION SECURITY INSURANCE COMPANY | 458 | $285K |
| Stop-loss / reinsurancereinsurance | AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXAS | 458 | $257K |
| Other | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | 79 | $12K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 458 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.