| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SVS INC | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | PRINCIPAL LIFE INSURANCE COMPANY | $8K | — | $8K | 2.76% |
| JOHN W LOWDERMILK3 | 5600 GREENWOOD PLAZA BOULEVARD SUITE 250 GREENWOOD VILLAGE, CA 80111 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $17K | — | $17K | 10.74% |
| RICHARD BLACKSTONE3 | 653 VERDANT PLACE VISTA, CA 92084 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8K | — | $8K | 6.70% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INS SVS | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5K | — | $5K | 3.94% |
| CLIENT BENEFIT INSURANCE SERVICES3 | 5675 RUFFIN ROAD SAN DIEGO, CA 92123 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $403 | $84 | $487 | 0.42% |
| UZIEL RIVERA3 | 543 CHEROKEE CIRCLE BANNING, CA 92220 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $327 | $123 | $450 | 0.39% |
| LORI LAINE3 | 35837 CARTER YUCAIPA, CA 92399 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $320 | $125 | $445 | 0.39% |
| VOLUNTARY SOLUTIONS INC3 | 195 TELLURIDE STREET BRIGHTON, CO 80601 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $189 | $90 | $279 | 0.24% |
| FREDRICK D BRADFORD3 | 16057 OAKLEY ROAD RAMONA, CA 92065 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $179 | — | $179 | 0.16% |
| BRETT WELTY INSURANCE AGENCY INC3 | 5675 RUFFIN ROAD SAN DIEGO, CA 92123 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $140 | $38 | $178 | 0.15% |
| ARIADNE DE BASABE-MACHICHE3 | 1102 NIMROD CIRCLE CORONA, CA 92880 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $135 | $5 | $140 | 0.12% |
| MICHAEL C WALKER3 Filed as: MICHAEL J MINNEY | PO BOX 365 POWAY, CA 92074 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $20 | — | $20 | 0.02% |
| JOHN D EVANGELISTA3 | 26111 ANTONIO PARKWAY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | $4 | $16 | 0.01% |
| UNIVERSAL BENEFIT INS AGY3 | C/O ANNABEL CURTIS SAINT GEORGE, UT 84771 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | — | $7 | 0.01% |
| JIM BARRETT3 | 8514 EAST KRAIL STREET SCOTTSDALE, AZ 85250 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.00% |
| CHERI L ROE3 | PO BOX 165 SANTA MARGARITA, CA 93453 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.00% |
| GROUP SUPPLEMENTAL BENEFITS INC3 Filed as: GROUP SUPPLEMENTAL BENEFITS, INC. | 31805 TEMECULA PARKWAY TEMECULA, CA 92592 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.00% |
| JOHN W LOWDERMILK3 | 5600 GREENWOOD PLAZA BOULEVARD SUITE 250 GREENWOOD VILALGE, CO 80111 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $10K | — | $10K | 13.67% |
| HEALTHSMART BENEFIT SOLUTIONS3 Filed as: HEALTHSMART BENEFIT SOLUTIONS, INC. | 10303 EAST DRY CREEK ROAD SUITE 200 ENGLEWOOD, CO 80112 | VISION SERVICE PLAN | $3K | $180 | $3K | 8.33% |
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 | 215 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 3 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 219 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 1,321 | $2.2M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 216 | $289K |
| Vision | VISION SERVICE PLAN | 213 | $36K |
| Life insurance(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 225 | $348K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 225 | $159K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 225 | $159K |
| Other(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 225 | $348K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,321 | — |
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.