| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BENEFITPRO INSURANCE SERVICES INC3 | 2655 CAMINO DEL RIO NORTH 370 SAN DIEGO, CA 92108 | SUN LIFE ASSURANCE COMPANY OF CANADA | $11K | — | $11K | 5.22% |
| ACRIALPS LLC3 | PO BOX 1788 GRAND RAPIDS, MI 49501 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $566 | $5K | 3.95% |
| BENEFITPRO INSURANCE SERVICES INC3 | 2655 CAMINO DEL RIO NORTH SAN DIEGO, CA 92108 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | — | $4K | 2.95% |
| RAYMOND KWOCKMAN GONG3 | 1907 COLUMBIA ST APT 501 SAN DIEGO, CA 92101 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $236 | $2K | 1.50% |
| KINGHOM & ASSOCIATES3 | PO BOX 211236 CHULA VISTA, CA 91921 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $501 | — | $501 | 0.42% |
| MELISSA D CARRILLO3 | 11310 CAM PLAYA CANCUN UNIT 4 SAN DIEGO, CA 92124 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $345 | — | $345 | 0.29% |
| G SCOTT COOKE3 Filed as: SCOTT C CASTEEL | 1450 W JAMES WAY ANAHEIM, CA 92801 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $325 | — | $325 | 0.27% |
| SUSIE A ESTRADA3 | 25742 PARK AVE SAN JUAN CAPISTRANO, CA 92675 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $261 | — | $261 | 0.22% |
| CHELSEA L WARE LLC3 Filed as: CHELSEA L WARE INC | 11425 PERUGINO DR LAS VEGAS, NV 89138 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $247 | — | $247 | 0.21% |
| MARTHA ANGELICA HILL ESTRADA3 | 2991 ESCALA CIR SAN DIEGO, CA 92108 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $159 | — | $159 | 0.13% |
| ROBERT C WAITE3 Filed as: ROBERT STUART KENCHEL | 2588 EL CAMINO REAL STE F188 CARLSBAD, CA 92008 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $137 | — | $137 | 0.11% |
| ANDREA MARIE TIERCE3 | 1199 MADRONE LN PLACERVILLE, CA 95667 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $134 | — | $134 | 0.11% |
| MICHAEL C WALKER3 Filed as: MICHAEL J MINNEY | PO BOX 365 POWAY, CA 92074 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $113 | — | $113 | 0.09% |
| BARBARA ELLEN SMITH3 | 4040 PEIDMONT DR SPC 228 HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $112 | — | $112 | 0.09% |
| JOHN D EVANGELISTA3 | 186 LAS FLORES ALISO VIEJO, CA 92656 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $59 | $45 | $104 | 0.09% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | PO BOX 6030 PASADENA, CA 91102 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $63 | — | $63 | 0.05% |
| RALPH F REA JR3 Filed as: RALPH F REA | 84 VIA BARCELONA RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $57 | — | $57 | 0.05% |
| LISA ANN DIMON3 | C/O LISA DIMON AUBURN, CA 95602 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $57 | — | $57 | 0.05% |
| ANTONIA MARIE HOLDEN3 Filed as: ANTONIA MANA HOLDEN | 8932 CREEKFORD DR LAKESIDE, CA 92040 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $56 | — | $56 | 0.05% |
| KARLA ALEXANDER3 | 3524 OBERON LN NORTH LAS VEGAS, NV 89032 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $51 | — | $51 | 0.04% |
| JENNIFER JEAN MOYA3 | 24548 VIA LAS LADERAS MURRIETA, CA 92562 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $46 | — | $46 | 0.04% |
| GROUP SUPPLEMENTAL BENEFITS INC3 | 39970 STACY CT MURRIETA, CA 92653 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $38 | — | $38 | 0.03% |
| MIKE MCCORMICK3 | 7 MONSERRAT PL FOOTHILL RANCH, CA 92610 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $37 | — | $37 | 0.03% |
| SAMAR BREIK ALBIN3 | 41572 VALOR DR MURRIETA, CA 92562 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $36 | — | $36 | 0.03% |
| ALEXANDRA DIANE SORRENTINO3 | 3055 RED SPRINGS DR LAS VEGAS, NV 89135 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $33 | — | $33 | 0.03% |
| TAMMY LYNN RANAHAN3 | 29356 STAGELINE CIR MENIFEE, CA 92584 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $32 | — | $32 | 0.03% |
| GEORGE MICHAEL SORRENTINO3 | 3055 RED SPRINGS DR LAS VEGAS, NV 89135 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | $16 | $21 | 0.02% |
| CHRISTINA STAHL3 | 9621 CANYON MESA DR LAS VEGAS, NV 89144 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | $16 | $21 | 0.02% |
| MARGARITA ALEJANDRA RAMIREZ3 | 1356 CALLE COLNETT SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $18 | — | $18 | 0.01% |
| WILLIAM L WISER3 | 12725 JARDIN RD SAN DIEGO, CA 92128 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $17 | — | $17 | 0.01% |
| WENDY DAWN PACK3 | 16109 WATT WAY RAMONA, CA 92065 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $17 | — | $17 | 0.01% |
| RYAN WARE3 | 11632 REGAL ROCK PL LAS VEGAS, NV 89138 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $17 | — | $17 | 0.01% |
| SHAWNEENA MERCADO OVERLY3 | 3958 PARKERS FRY FORT MILL, SC 29715 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $17 | — | $17 | 0.01% |
| ERIC ALEXANDER NOVOA3 | 17871 SHADY VIEW DR UNIT 1503 CHINO HILLS, CA 91709 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $15 | — | $15 | 0.01% |
| ABRAMS MARKETING INC3 | 9538 W PICO BLVD STE 204 LOS ANGELES, CA 90035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $13 | — | $13 | 0.01% |
| SEAN MICHAEL STORY3 Filed as: SEAN M STORY LLC | 14148 MAHOGANY AVE JACKSONVILLE, FL 32258 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | — | $10 | 0.01% |
| JOSEPH RUBINO3 Filed as: JOSEPH THOMAS RUBINO | 2490 GROSSMONT COLLEGE DR EL CAJON, CA 92020 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | — | $10 | 0.01% |
| LOYDA VALDEZ3 | 546 S 400 E IVINS, UT 84738 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | — | $9 | 0.01% |
| COURTNEY MCFARLAND3 | 8321 W SAHARA AVE APT 2128 LAS VEGAS, NV 89117 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.00% |
| ELTHON ISRAEL CRUZ3 | 893 S 2100 W OREM, UT 84059 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.00% |
| ASSUREDPARTNERS3 Filed as: JENNIFER RENEE BLAIR | 3949 CARLA ANN RD NORTH LAS VEGAS, NV 89081 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.00% |
| MEGAN WILSON3 | 7534 SLIPPER ORCHID ST LAS VEGAS, NV 89148 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 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% |
| ELTHON ISRAEL CRUZ3 | 244 S 1200 E PAYSON, UT 84651 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | — | — | $0 | 0.00% |
| MARTHA ANGELICA HILL ESTRADA3 | 2991 ESCALA CIRCLE SAN DIEGO, CA 92108 | 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% |
| 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% |
| BARBARA ELLEN SMITH3 | 4040 EAST PIEDMONT DR HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | — | — | $0 | 0.00% |
| ACRIALPS LLC3 | PO BOX 1788 GRAND RAPIDS, MI 49501 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $102 | $1K | 4.54% |
| BENEFITPRO INSURANCE SERVICES INC3 | 2655 CAMINO DEL RIO NORTH SAN DIEGO, CA 92108 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 3.79% |
| RAYMOND KWOCKMAN GONG3 Filed as: RAYMOND KWOKMAN GONG | 1907 COLUMBIA ST APT 501 SAN DIEGO, CA 92101 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $978 | $174 | $1K | 3.66% |
| CHELSEA L WARE LLC3 Filed as: CHELSEA L WARE INC | 11425 PERUGINO DR LAS VEGAS, NV 89138 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $94 | — | $94 | 0.30% |
| ROGER STUART KENCHEL3 | 2588 EL CAMINO REAL STE F188 CARLSBAD, CA 92008 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $80 | — | $80 | 0.25% |
| MELISSA D CARRILLO3 | 11310 CAM PLAYA CANCUN UNIT 4 SAN DIEGO, CA 92124 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $60 | — | $60 | 0.19% |
| MICHAEL C WALKER3 Filed as: MICHAEL J MINNEY | PO BOX 365 POWAY, CA 92074 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $60 | — | $60 | 0.19% |
| JOHN D EVANGELISTA3 | 186 LAS FLORES ALISO VIEJO, CA 92656 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $24 | $18 | $42 | 0.13% |
| GEORGE MICHAEL SORRENTINO3 | 3055 RED SPRINGS DR LAS VEGAS, NV 89135 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | $24 | $31 | 0.10% |
| CHRISTINA STAHL3 | 9621 CANYON MESA DR LAS VEGAS, NV 89144 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | $24 | $31 | 0.10% |
| ANDREA MARIE TIERCE3 | 1199 MADRONE LN PLACERVILLE, CA 95667 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $24 | — | $24 | 0.08% |
| MARTHA ANGELICA HILL ESTRADA3 | 2991 ESCALA CIR SAN DIEGO, CA 92108 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $22 | — | $22 | 0.07% |
| TAMMY LYNN RANAHAN3 | 29356 STAGELINE CIR MENIFEE, CA 92584 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $19 | — | $19 | 0.06% |
| SEAN MICHAEL STORY3 Filed as: SEAN M STORTY LLC | 14148 MAHOGANY AVE JACKSONVILLE, FL 32258 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $18 | — | $18 | 0.06% |
| LORI LAINE3 | 34676 CONADRIA AVE YUCAIPA, CA 92399 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | $12 | $18 | 0.06% |
| SAMANTHA JACOBS3 | 5056 PLAZA PROMENADE SAN DIEGO, CA 92123 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | — | $12 | 0.04% |
| MARGARITA ALEJANDRA RAMIREZ3 | 1356 CALLE COLNETT SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | — | $7 | 0.02% |
| LOYDA VALDEZ3 | 546 S 400 E IVINS, UT 84738 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | — | $6 | 0.02% |
| RYAN WARE3 | 11632 REGAL ROCK PL LAS VEGAS, NV 89138 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | — | $6 | 0.02% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | PO BOX 6030 PASADENA, CA 91102 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.01% |
| WENDY DAWN PACK3 | 16109 WATT WAY RAMONA, CA 92065 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.01% |
| MEGAN WILSON3 | 7534 SLIPPER ORCHID ST LAS VEGAS, NV 89148 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| ABRAMS MARKETING INC3 | 9538 W PICO BLVD STE 204 LOS ANGELES, CA 90035 | 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 | 10.82% |
| DAVID QUACKENBUSH4 | 21783 E ROWLAND CIR AURORA, CO 80016 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $471 | — | $471 | 6.95% |
| BRANDEN R SAMANIEGO4 | 31860 RUTH LN HOMELAND, CA 92548 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $463 | — | $463 | 6.83% |
| 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 | $20 | — | $20 | 0.30% |
| ANNETTE E WHITE INS SERVICES INC4 | 10755 SCRIPPS POWAY PARKWAY 454 SAN DIEGO, CA 92131 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | — | — | $0 | 0.00% |
| BENEFITPRO INSURANCE SERVICES INC3 | 2655 CAMINO DEL RIO NORTH SAN DIEGO, CA 92108 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $177 | — | $177 | 8.97% |
| MELISSA D CARRILLO3 | 11310 CAM PLAYA CANCUN UNIT 4 SAN DIEGO, CA 92124 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $30 | — | $30 | 1.52% |
| RAYMOND KWOCKMAN GONG3 Filed as: RAYMOND KWOKMAN GONG | 1907 COLUMBIA ST APT 501 SAN DIEGO, CA 92101 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $29 | — | $29 | 1.47% |
| ACRIALPS LLC3 | PO BOX 1788 GRAND RAPIDS, MI 49501 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $24 | — | $24 | 1.22% |
| MICHAEL C WALKER3 Filed as: MICHAEL J MINNEY | PO BOX 365 POWAY, CA 92074 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $18 | — | $18 | 0.91% |
| ANDREA MARIE TIERCE3 | 1199 MADRONE LN PLACERVILLE, CA 95657 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $13 | — | $13 | 0.66% |
| ANTONIA DAVILA3 Filed as: ANTONIA MARIA HOLDEN | 8932 CREEKFORD DRIVE LAKESIDE, CA 92040 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.15% |
| CHELSEA L WARE LLC3 Filed as: CHELSEA L WARE INC | 11425 PERUGINO DR LAS VEGAS, NV 89138 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.05% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMPASS HEALTH ADMINISTRATORS EIN 82-2891309 PLAN ADMINISTRATOR | Plan Administrator Service code 14 | 30 E RIVERARK PLACE WEST SUITE 180 FRESNO, CA 93720 | $78K |
| BLUE SHIELD OF CALIFORNIA EIN 94-0360524 CLAIMS PROCESSING | Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services Service code 12 | 601 12TH STREET OAKLAND, CA 94607 | $63K |
| BEESON HOFFMAN & SIDDALL INC EIN 95-3654092 PLAN AUDITOR | Accounting (including auditing) Service code 10 | 500 NORTH CENTRAL AVENUE STE 325 GLENDALE, CA 91203 | $22K |
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 | 436 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 436 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | SUN LIFE ASSURANCE COMPANY OF CANADA | 338 | $207K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 317 | $22K |
| Life insurance(4 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 338 | $361K |
| Stop-loss / reinsurancereinsurance | AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXAS | 0 | $520K |
| Other | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | 36 | $7K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 338 | — |
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.