| 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 | SUN LIFE ASSURANCE COMPANY OF CANADA | $8K | — | $8K | 5.67% |
| 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 | $4K | — | $4K | 2.92% |
| MELISSA D CARRILLO3 | 9469 FAIRGROVE LANE SAN DIEGO, CA 92129 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $2 | $3K | 2.55% |
| RAYMOND KWOCKMAN GONG3 | 2180 FENTON PARKWAY SAN DIEGO, CA 92108 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $334 | $3K | 2.10% |
| MARTHA ANGELICA HILL ESTRADA3 | 2991 ESCALA CIRCLE SAN DIEGO, CA 92108 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $567 | $2K | 1.43% |
| ANDREA MARIE TIERCE3 | 2204 PLEASANTWOOD LANE ESCONDIDO, CA 92026 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $516 | $2K | 1.32% |
| GEORGE MICHAEL SORRENTINO3 | 1123 ALEXANDRIA DR SAN DIEGO, CA 92107 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $783 | — | $783 | 0.61% |
| KINGHORN & ASSOCIATES3 Filed as: KINGHORN & ASSOCIATES INS & FIN | PO BOX 225 BONITA, CA 91908 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $767 | — | $767 | 0.60% |
| DEL DOWNEY3 | 41960 AVENIDA DE ANITA TEMECULA, CA 92592 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $449 | $93 | $542 | 0.42% |
| MICHAEL C WALKER3 Filed as: MICHAEL J MINNEY | PO BOX 365 POWAY, CA 92074 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $496 | $14 | $510 | 0.40% |
| G SCOTT COOKE3 Filed as: SCOTT C CASTEEL | 1450 WEST JAMES WAY ANAHEIM, CA 92801 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $436 | — | $436 | 0.34% |
| SUSIE A ESTRADA3 | 25742 PARK AVENUE SAN JUAN CAPISTRANO, CA 92675 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $326 | — | $326 | 0.25% |
| ELTHON ISRAEL CRUZ3 | 244 S 1200 E PAYSON, UT 84651 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $279 | $1 | $280 | 0.22% |
| CLIENT BENEFIT INSURANCE SERVICES3 | 5675 RUFFIN ROAD SAN DIEGO, CA 92123 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $237 | $35 | $272 | 0.21% |
| CHRISTINA D POLK INC3 | 9755 QUENCIA CT LAS VEGAS, NV 89149 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $269 | — | $269 | 0.21% |
| CYNTHIA BETH GOLDEN3 | 27500 BOTTLE BRUSH WAY MURRIETA, CA 92562 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $251 | — | $251 | 0.20% |
| BELLA NATION BENEFITS LLC3 Filed as: BELLA NATION BENEFITS INC | 8693 TARA HILL AVE LAS VEGAS, NV 89148 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $226 | — | $226 | 0.18% |
| LISA ANN DIMON3 | C/O LISA DIMON BUHL, ID 83316 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $205 | — | $205 | 0.16% |
| BUILDING BLOCKS FOR BUSINESS LLC3 | 6170 N DURANGO DR STE 200 LAS VEGAS, NV 89149 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $121 | $37 | $158 | 0.12% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY INSURANCE BROKERS | PO BOX 6030 PASADENA, CA 91102 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $137 | — | $137 | 0.11% |
| CHARLES D. BLOCK3 Filed as: CHARLES DUANE SMITH | 4040 EAST PIEDMONT DR HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $111 | — | $111 | 0.09% |
| RALPH F REA JR3 | 84 VIA BARCELONA RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $104 | — | $104 | 0.08% |
| KJM MANAGEMENT LLC3 | 4459 CLAIRMONT DRIVE UNIT B SAN DIEGO, CA 92117 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $88 | — | $88 | 0.07% |
| GROUP SUPPLEMENTAL BENEFITS INC3 | 1003 EAST COOLEY DR COLTON, CA 92324 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $85 | — | $85 | 0.07% |
| TAMMY VAN HOUTEN-THOMPSON3 | 8693 TARA HILL AVE LAS VEGAS, NV 89148 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $82 | — | $82 | 0.06% |
| ANTONIA MARIE HOLDEN3 | 8932 CREEKFORD ST LAKESIDE, CA 92040 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $59 | $1 | $60 | 0.05% |
| SAMAR BREIK ALBIN3 | 41572 VALOR DR MURRIETA, CA 92562 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $59 | — | $59 | 0.05% |
| MIKE MCCORMICK3 | 7 MONSERRAT PL FOOTHILL RANCH, CA 92610 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $45 | — | $45 | 0.04% |
| MARGARITA ALEJANDRA RAMIREZ3 | 1356 CALLE COLNETT SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $41 | — | $41 | 0.03% |
| WENDY DAWN PACK3 | 16109 WATT WAY RAMONA, CA 92065 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $39 | — | $39 | 0.03% |
| ABRAMS MARKETING INC3 | 9538 W PICO BLVD LOS ANGELS, CA 90035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $31 | — | $31 | 0.02% |
| JOSEPH RUBINO3 | 2490 GROSSMONT COLLEGE DR EL CAJON, CA 92020 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $21 | — | $21 | 0.02% |
| WILLIAM L WISER3 | 12725 JARDIN RD SAN DIEGO, CA 92128 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $17 | — | $17 | 0.01% |
| CHELSEA L WARE LLC3 | 9755 QUENCIA CT LAS VEGAS, NV 89149 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | — | $9 | 0.01% |
| COURTNEY MCFARLAND3 | 852 BAYWOOD DR NEWPORT BEACH, CA 92660 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | — | $7 | 0.01% |
| ROBERT C WAITE3 Filed as: ROBERT STUART KENCHEL | 2588 EL CAMINO REAL CARLSBAD, CA 92008 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | — | $6 | 0.00% |
| JIM BARRETT3 | 8514 EAST KRAIL ST SCOTTSDALE, AZ 85250 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.00% |
| JENNIFER AURORA RAMIREZ3 | 1053 FICUS LANE SAN MARCOS, CA 92069 | 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 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $2K | — | $2K | 10.93% |
| BRANDEN R SAMANIEGO4 | 31860 RUTH LN HOMELAND, CA 92548 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $2K | — | $2K | 16.91% |
| DAVID QUACKENBUSH4 | 5353 SOUTH GENOA WAY CENTENNIAL, CO 80015 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $1K | — | $1K | 10.12% |
| 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 | $67K |
| BLUE CROSS LIFE & HEALTH EIN 95-4331852 CLAIMS PROCESSING | Claims processing; Other services; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | 21555 OXNARD WOODLAND HILLS, CA 91367 | $56K |
| 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 | $48K |
| TC3 HEALTH INC EIN 13-4346850 BENEFITS REVIEW | Consulting (general) Service code 16 | 19732 MACURTHUR BLVD 100 IRVINE, CA 92612 | $983 |
| FIRST HEALTH GROUP CORPORATION EIN 20-1736437 PPO-PREF PROV NETWORK | Insurance services Service code 23 | 23291 NETWORK PLACE CHICAGO, IL 606731233 | $530 |
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 | 300 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 300 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | SUN LIFE ASSURANCE COMPANY OF CANADA | 285 | $140K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 277 | $19K |
| Life insurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 285 | $268K |
| Stop-loss / reinsurancereinsurance | AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXAS | 300 | $264K |
| Other | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | 71 | $12K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 300 | — |
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.