| 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 | $11K | — | $11K | 5.88% |
| 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 | $9K | — | $9K | 6.83% |
| BUILDING BLOCKS FOR BUSINESS LLC3 | 10845 GRIFFITH PEAK DR LAS VEGAS, NV 89135 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $652 | $3K | 2.26% |
| RAYMOND KWOCKMAN GONG3 | 2180 FENTON PARKWAY APT 214 SAN DIEGO, CA 92108 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $628 | $3K | 1.87% |
| ROGER STUART KENCHEL3 | 2588 EL CAMINO REAL CARLSBAD, CA 92008 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $844 | $210 | $1K | 0.76% |
| ALEXANDRIA DIANE SORRENTINO3 | 3055 RED SPRINGS DR LAS VEGAS, NV 89135 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $455 | $381 | $836 | 0.60% |
| GEORGE MICHAEL SORRENTINO3 | 1123 ALEXANDRIA DR SAN DIEGO, CA 92107 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $589 | — | $589 | 0.42% |
| ANTONIA MARIE HOLDEN3 | 8932 CREEKFORD ST LAKESIDE, CA 92040 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $347 | $185 | $532 | 0.38% |
| KARLA ALEXANDER3 | 1612 EAGLE PEAK WAY LAS VEGAS, NV 89134 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $411 | $21 | $432 | 0.31% |
| G SCOTT COOKE3 Filed as: SCOTT C CASTEEL | 1450 WEST JAMES WAY ANAHEIM, CA 92801 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $389 | — | $389 | 0.28% |
| SUSIE A ESTRADA3 | 25742 PARK AVENUE SAN JUAN CAPISTRANO, CA 92675 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $311 | — | $311 | 0.22% |
| ANDREA MARIE TIERCE3 | 2204 PLEASANTWOOD LANE ESCONDIDO, CA 92026 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $232 | — | $232 | 0.17% |
| LISA ANN DIMON3 | C/O LISA DIMON AUBRN, CA 95602 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $224 | — | $224 | 0.16% |
| TAMMY VAN HOUTEN-THOMPSON3 | 8693 TARA HILL AVE LAS VEGAS, NV 89148 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $219 | — | $219 | 0.16% |
| MEGAN WILSON3 | 7534 SLIPPER ORCHID STREET LAS VEGAS, NV 89148 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $183 | $28 | $211 | 0.15% |
| SEAN MICHAEL STORY3 Filed as: SEAN STORY | 14148 MAHOGANY AVE JACKSONVILLE, FL 32258 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $207 | — | $207 | 0.15% |
| MARIA YVONNE RODIGHIERO3 | 28502 SHRIKE DRIVE LAGUNA NIGUEL, CA 92677 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $184 | $22 | $206 | 0.15% |
| CHRISTINA D POLK INC3 | 8972 ECHO RIDGE DR LAS VEGAS, NV 89117 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $194 | — | $194 | 0.14% |
| MICHAEL C WALKER3 Filed as: MICHAEL J MINNEY | PO BOX 365 POWAY, CA 92074 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $177 | — | $177 | 0.13% |
| DOMINICK R SIRACUSA3 Filed as: DOMINICK MICHAEL SORRENTINO | 104 STOCKTON KINGS COURT LAS VEGAS, NV 89148 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $141 | $24 | $165 | 0.12% |
| ERIK ALEXANDER NOVOA3 | 17871 SHADY VIEW DR CHINO HILLS, CA 91709 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $104 | $31 | $135 | 0.10% |
| MARTHA ANGELICA HILL ESTRADA3 | 2991 ESCALA CIRCLE SAN DIEGO, CA 92108 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $128 | — | $128 | 0.09% |
| CHARLES D. BLOCK3 Filed as: CHARLES DUANE SMITH | 4040 EAST PIEDMONT DR HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $122 | — | $122 | 0.09% |
| GROUP SUPPLEMENTAL BENEFITS INC3 | 1003 EAST COOLEY DR COLTON, CA 92324 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $90 | — | $90 | 0.06% |
| ELIZABETH DOREEN GARCIA SALAS3 | 447 BOUGHER RD SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $38 | — | $38 | 0.03% |
| ASSUREDPARTNERS3 Filed as: JENNIFER RENEE BLAIR | 3305 EAST ROME BLVD NORTH LAS VEGAS, NV 89086 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $20 | $6 | $26 | 0.02% |
| WENDY DAWN PACK3 | 16109 WATT WAY RAMONA, CA 92065 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $25 | — | $25 | 0.02% |
| WILLIAM L WISER3 | 12725 JARDIN RD SAN DIEGO, CA 92128 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $19 | — | $19 | 0.01% |
| JOHN D EVANGELISTA3 | 151 LAS FLORES ALISO VIEJO, CA 92656 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | $10 | $17 | 0.01% |
| JOSEPH RUBINO3 | 2490 GROSSMONT COLLEGE DR EL CAJON, CA 92020 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $11 | — | $11 | 0.01% |
| JASON MICHAEL SAYLOR3 | 3647 LAGUNA VENETA AVE LAS VEGAS, NV 89141 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.00% |
| SAMAR BREIK ALBIN3 | 41572 VALOR DR MURRIETA, CA 92562 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | — | — | $0 | 0.00% |
| CLIENT BENEFIT INSURANCE SERVICES3 | 5675 RUFFIN ROAD SAN DIEGO, CA 92123 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | — | — | $0 | 0.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY INSURANCE BROKERS | PO BOX 6030 PASADENA, CA 91102 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | — | — | $0 | 0.00% |
| CHELSEA L WARE LLC3 | 9755 QUENCIA CT LAS VEGAS, NV 89149 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | — | — | $0 | 0.00% |
| TAMMY VAN HOUTEN-THOMPSON3 | 8693 TARA HILL AVE LAS VEGAS, NV 89148 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | — | — | $0 | 0.00% |
| COURTNEY MCFARLAND3 | 852 BAYWOOD DR NEWPORT BEACH, CA 92660 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | — | — | $0 | 0.00% |
| ELTHON ISRAEL CRUZ3 | 244 S 1200 E PAYSON, UT 84651 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | — | — | $0 | 0.00% |
| CYNTHIA BETH GOLDEN3 | 27500 BOTTLE BRUSH WAY MURRIETA, CA 92562 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | — | — | $0 | 0.00% |
| ABRAMS MARKETING INC3 | 9538 W PICO BLVD LOS ANGELS, CA 90035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | — | — | $0 | 0.00% |
| JOHN D EVANGELISTA3 | 26111 ANTONIO PARKWAY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | — | — | $0 | 0.00% |
| JENNIFER JEAN MOYA3 | 24548 VIA LAS LADERAS MURRIETA, CA 92562 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | — | — | $0 | 0.00% |
| LETICIA ISABEL BENITEZ3 | 2160 UNIVERSITY DRIVE VISTA, CA 92083 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | — | — | $0 | 0.00% |
| MARIA EUGENIA GONZALEZ3 | 5055 LINDELL RD APT 1099 LAS VEGAS, NV 89118 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | — | — | $0 | 0.00% |
| LOYDA VALDEZ3 | 1511 CARDINAL PEAK LANE LAS VEGAS, NV 89144 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | — | — | $0 | 0.00% |
| MIKE MCCORMICK3 | 7 MONSERRAT PL FOOTHILL RANCH, CA 92610 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | — | — | $0 | 0.00% |
| MARGARITA ALEJANDRA RAMIREZ3 | 1356 CALLE COLNETT SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | — | — | $0 | 0.00% |
| MELISSA D CARRILLO3 | 9469 FAIRGROVE LANE SAN DIEGO, CA 92129 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | — | — | $0 | 0.00% |
| RALPH F REA JR3 | 84 VIA BARCELONA RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | — | — | $0 | 0.00% |
| KINGHORN & ASSOCIATES3 Filed as: KINGHORN & ASSOCIATES INS & FIN | PO BOX 225 BONITA, CA 91908 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | — | — | $0 | 0.00% |
| JENNIFER AURORA RAMIREZ3 | 1053 FICUS LANE SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | — | — | $0 | 0.00% |
| DEL DOWNEY3 | 41960 AVENIDA DE ANITA TEMECULA, CA 92592 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | — | — | $0 | 0.00% |
| KJM MANAGEMENT LLC3 | 4459 CLAIRMONT DRIVE UNIT B SAN DIEGO, CA 92117 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | — | — | $0 | 0.00% |
| JIM BARRETT3 | 8514 EAST KRAIL ST SCOTTSDALE, AZ 85250 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | — | — | $0 | 0.00% |
| BELLA NATION BENEFITS LLC3 Filed as: BELLA NATION BENEFITS INC | 8693 TARA HILL AVE LAS VEGAS, NV 89148 | 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 | 8.35% |
| BRANDEN R SAMANIEGO4 | 31860 RUTH LN HOMELAND, CA 92548 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $975 | — | $975 | 10.68% |
| DAVID QUACKENBUSH4 | 5353 SOUTH GENOA WAY CENTENNIAL, CO 80015 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $836 | — | $836 | 9.16% |
| ANNETTE E WHITE INS SERVICES INC4 | 10755 SCRIPPS POWAY PARKWAY 454 SAN DIEGO, CA 92131 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $31 | — | $31 | 0.34% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EBA&M CORPORATION EIN 95-2881702 PLAN ADMINISTRATOR | Plan Administrator Service code 14 | 18002 COWAN IRVINE, CA 92614 | $75K |
| 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 | $62K |
| BLUE CROSS LIFE & HEALTH EIN 95-4331852 CLAIMS PROCESSING | Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing Service code 12 | 21555 OXNARD WOODLAND HILLS, CA 91367 | $62K |
| FIRST HEALTH GROUP CORPORATION EIN 20-1736437 PPO-PREF PROV NETWORK | Insurance services Service code 23 | 23291 NETWORK PLACE CHICAGO, IL 606731233 | $160 |
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 | 258 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 258 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | SUN LIFE ASSURANCE COMPANY OF CANADA | 331 | $180K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 315 | $20K |
| Life insurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 331 | $319K |
| Stop-loss / reinsurancereinsurance | AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXAS | 0 | $0 |
| Other | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | 66 | $9K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 331 | — |
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.
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.