| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | ATTN ACCOUNTING DEPT 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | PRINCIPAL LIFE INSURANCE COMPANY | $9K | — | $9K | 2.99% |
| JOHN W LOWDERMILK3 | SUITE 250 5600 GREENWOOD PLAZA BOULEVARD GREENWOOD VILLAGE, CO 80111 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $16K | — | $16K | 10.84% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6K | — | $6K | 4.56% |
| LORI LAINE3 | 35837 CARTER ST YUCAIPA, CA 92399 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $602 | $5K | 3.83% |
| CLIENT BENEFIT INSURANCE SERVICES3 | 5675 RUFFIN ROAD SAN DIEGO, CA 92123 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $225 | $3K | 2.34% |
| RICHARD BLACKSTONE3 | 6374 CHAFFEE ST VENTURA, CA 93003 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | — | $3K | 2.13% |
| RAYMOND KWOCKMAN GONG3 Filed as: RAYMOND KWOKMAN GONG | 2180 FENTON PKWY SAN DIEGO, CA 92108 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $499 | $132 | $631 | 0.50% |
| UZIEL RIVERA3 | 1267 SILVER TORCH DR BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $371 | $107 | $478 | 0.38% |
| VOLUNTARY SOLUTIONS INC3 | 509 SOUTH 4TH AVE BRIGHTON, CO 80601 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $249 | $155 | $404 | 0.32% |
| FREDRICK D BRADFORD3 | 16057 OAKLEY ROAD RAMONA, CA 92065 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $143 | — | $143 | 0.11% |
| BRETT WELTY INSURANCE AGENCY INC3 | 5675 RUFFIN RD SAN DIEGO, CA 92123 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $83 | $3 | $86 | 0.07% |
| JOHN D EVANGELISTA3 | 26111 ANTONIO PKWY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $17 | $10 | $27 | 0.02% |
| MICHAEL C WALKER3 Filed as: MICHAEL J MINNEY | P O BOX 365 POWAY, CA 92074 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $18 | — | $18 | 0.01% |
| UNIVERSAL BENEFIT INS AGY3 | C/O ANNABEL BURTIS SAINT GEORGE, UT 84771 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | — | $6 | 0.00% |
| JIM BARRETT3 Filed as: JIM BARRET | 8514 EAST KRAIL ST SCOTTSDALE, AZ 85250 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.00% |
| CHERI L ROE3 | P O 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 | $1 | — | $1 | 0.00% |
| JOHN W LOWDERMILK3 | SUITE 250 5600 GREENWOOD PLAZA BOULEVARD GREENWOOD VILLAGE, CO 80111 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $14K | — | $14K | 16.29% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | — | VISION SERVICE PLAN | $4K | $180 | $4K | 9.17% |
| LOWDERMILK & ASSOCIATES, INC3 Filed as: LOWDERMILK, JOHN W | STE 250 5600 GREENWOOD PLAZA BLVD GREENWOOD VILLAGE, CO 80111 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 10.91% |
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 | 260 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 7 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 270 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 463 | $2.6M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 559 | $314K |
| Vision | VISION SERVICE PLAN | 249 | $43K |
| Life insurance(4 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 221 | $392K |
| Short-term disability(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 221 | $179K |
| Long-term disability(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 221 | $179K |
| Other(4 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 221 | $392K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 559 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.