| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIGITAL INSURANCE LLC3 | 200 GALLERIA PARKWAY SE, SUITE 1950 ATLANTA, GA 303395946 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $11K | $11K | 2.56% |
| DIGITAL INSURANCE LLC3 | 200 GALLERIA PARKWAY SE, SUITE 1950 ATLANTA, GA 303395946 | PRINCIPAL LIFE INSURANCE COMPANY | $12K | — | $12K | 10.19% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 1600 W. HILLSDALE BLVD, SUITE 201 SAN MATEO, CA 944023766 | PRINCIPAL LIFE INSURANCE COMPANY | $3K | $595 | $4K | 3.31% |
| JOHN D EVANGELISTA3 Filed as: JOHN D. EVANGELISTA | 151 LAS FLORES ALISO VIEJO, CA 92656 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $2K | $4K | 10.58% |
| DIGITAL INSURANCE LLC3 | 200 GALLERIA PARKWAY SE, SUITE 1950 ATLANTA, GA 303395946 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $489 | $3K | 7.31% |
| BENEFITS COORDINATOR3 | 10741 LA JARA STREET CERRITOS, CA 90703 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $588 | $471 | $1K | 2.82% |
| ANTOINETTE MARI GARCIA3 | 1745 ORANGEWOOD AVENUE, SUITE 212 ORANGE, CA 92868 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $680 | $5 | $685 | 1.82% |
| NICHOLAS RYAN DERRICO3 | 1745 W ORANGEWOOD AVENUE, SUITE 212 ORANGE, CA 92868 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $303 | $2 | $305 | 0.81% |
| UZIEL RIVERA3 | 1267 SILVER TORCH DRIVE BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $201 | $42 | $243 | 0.65% |
| JESSICA RENEE GREENE3 | 630 S INDIAN HILLS BOULEVARD CLAREMONT, CA 91711 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $126 | — | $126 | 0.34% |
| TECH COORDINATOR CYBER INSURANCE SO3 | 10741 LA JARA STREET CERRITOS, CA 90703 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $85 | $18 | $103 | 0.27% |
| ERIC ALEXANDER NOVOA3 | 17871 SHADY VIEW DRIVE CHINO HILLS, CA 91709 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $64 | $20 | $84 | 0.22% |
| NATIONAL ENROLLMENT PARTNERS LLC3 | 201 CAUGHMAN FARM LANE LEXINGTON, SC 29072 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $21 | $59 | $80 | 0.21% |
| BARBARA K GROSS3 | 15 WEBER ROAD JEANNETTE, PA 15644 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $13 | — | $13 | 0.03% |
| JONATHAN MARK DAHL3 | 1722 DIXON STREET REDONDO BEACH, CA 90278 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | — | $12 | 0.03% |
| LUZ CASTILLO BARRIGA3 | 22019 JUAN AVENUE HAWAIIAN GARDENS, CA 90716 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | — | $10 | 0.03% |
| EDITH VIEYRA3 | 1432 EAST MARKET STREET LONG BEACH, CA 90805 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | — | $7 | 0.02% |
| DONNA TROXELL3 | 706 WESTWOOD DRIVE GIBSONIA, PA 15044 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.01% |
| BENECHOICE ENROLLMENT SOLUTIONS & T3 | 1574 LITITZ PIKE LANCASTER, PA 17601 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.01% |
| JAMES BARTLETT LLC3 | 3138 GREENRIDGE DRIVE LANCASTER, PA 17601 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.01% |
| HAD LI ENTERPRISES INCORPORATED3 | 11432 SOUTH STREET, #303 CERRITOS, CA 90703 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| ANAHI RIES3 | 250 PACIFIC AVENUE, APT 423 LONG BEACH, CA 90802 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
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 | 169 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 169 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 179 | $414K |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 264 | $119K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 264 | $119K |
| Life insurance(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 264 | $157K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 34 | $38K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 179 | $414K |
| Other(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 264 | $157K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 264 | — |
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.