| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CANINI INSURANCE MARKETING3 | PO BOX 1250 HUNTINGTON BEACH, CA 92647 | KAISER FOUNDATION HEALTH PLAN INC | $40K | $0 | $40K | 2.61% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 18201 VON KARMAN AVENUE, SUITE 200 IRVINE, CA 92612 | KAISER FOUNDATION HEALTH PLAN INC | $14K | $0 | $14K | 0.89% |
| JOHN D EVANGELISTA3 Filed as: JOHN D. EVANGELISTA | 26111 ANTONIO PARKWAY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $2K | $4K | 18.78% |
| CANINI INSURANCE MARKETING3 | PO BOX 1250 HUNTINGTON BEACH, CA 92647 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $0 | $2K | 8.30% |
| MARIA C GONZALEZ3 Filed as: MARIA C. GONZALEZ | 11677 SANDPIPER COURT MORENO VALLEY, CA 92557 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $439 | $62 | $501 | 2.51% |
| BENEFITS COORDINATOR3 | 10741 LA JARA STREET CERRITOS, CA 90703 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $298 | $148 | $446 | 2.23% |
| RAYMOND KWOCKMAN GONG3 | 2180 FENTON PARKWAY SAN DIEGO, CA 92108 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $250 | $71 | $321 | 1.61% |
| CHAU PHAN3 | 6 FOREST IRVINE, CA 92612 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $157 | $4 | $161 | 0.81% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 18201 VON KARMAN AVENUE, SUITE 200 IRVINE, CA 92612 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2 | $0 | $2 | 0.01% |
| CANINI INSURANCE MARKETING3 | PO BOX 1250 HUNTINGTON BEACH, CA 92647 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $600 | $0 | $600 | 9.23% |
| JOHN D EVANGELISTA3 Filed as: JOHN D. EVANGELISTA | 26111 ANTONIO PARKWAY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $73 | $28 | $101 | 1.55% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 18201 VON KARMAN AVENUE, SUITE 200 IRVINE, CA 92612 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $57 | $1 | $58 | 0.89% |
| BENEFITS COORDINATOR3 | 10741 LA JARA STREET CERRITOS, CA 90703 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $36 | $5 | $41 | 0.63% |
| GARNETT POWERS & ASSOCIATES INC3 Filed as: GARNETT-POWERS AND ASSOCIATES | 25909 PALA, SUITE 120 MISSION VIEJO, CA 92691 | CALIFORNIA DENTAL NETWORK, INC. | $459 | $0 | $459 | 8.50% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 18201 VON KARMAN AVENUE, SUITE 200 IRVINE, CA 92612 | CALIFORNIA DENTAL NETWORK, INC. | $81 | $0 | $81 | 1.50% |
No Schedule C service providers reported on this filing.
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 | 100 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 103 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 236 | $1.5M |
| Dental | CALIFORNIA DENTAL NETWORK, INC. | 30 | $5K |
| Life insurance(2 contracts) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 159 | $26K |
| Short-term disability | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 24 | $20K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 236 | $1.5M |
| Other(2 contracts) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 159 | $26K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 236 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.