| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NIELSEN INSURANCE GROUP INC3 | 4165 EAST THOUSAND OAKS BOULEVARD SUITE 325 WESTLAKE VILLAGE, CA 91362 | BLUE CROSS OF CALIFORNIA | $26K | — | $26K | 5.75% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES L | 1600 WEST HILLSDALE BOULEVARD SUITE 201 SAN MATEO, CA 94403 | BLUE CROSS OF CALIFORNIA | — | $2K | $2K | 0.40% |
| ADSH INVESTMENTS3 Filed as: ADSH INVESTMENTS II INC | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | BLUE CROSS OF CALIFORNIA | $1 | — | $1 | 0.00% |
| LORI ROBIN NISHIMORI3 | 9204 HOXIE COURT BAKERSFIELD, CA 93311 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $362 | $3K | 6.79% |
| NIELSEN INSURANCE GROUP INC3 | 4165 EAST THOUSAND OAK BOULEVARD WESTLAKE VILLAGE, CA 91362 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 5.36% |
| ANDREA MARIE TIERCE3 | 1199 MADRONE LANE PLACERVILLE, CA 95667 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $623 | $207 | $830 | 2.05% |
| ARACELI MEDINA PANIAGUA3 | 400 ROYAL WAY BAKERSFIELD, CA 93306 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $564 | — | $564 | 1.39% |
| INSURICA, INC.3 Filed as: INSURICA CA INSURANCE SERVICES INC | — | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $313 | — | $313 | 0.77% |
| BENEFITS EXCHANGE ALLIANCE3 Filed as: BENEFITS EXCHANGE ALLIANCE INC | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $259 | — | $259 | 0.64% |
| VONDA KAY PERALEZ3 | 6409 RIO DE JANEIRO AVENUE BAKERSFIELD, CA 93313 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $182 | — | $182 | 0.45% |
| BART EHINGER3 | 715 AVOCET WAY ARROYO GRANDE, CA 93420 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $117 | — | $117 | 0.29% |
| DUANE A ADAMS3 Filed as: DUANE ANDREW FRY | 3707 ANITA AVENUE PASADENA, CA 91107 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $34 | $52 | $86 | 0.21% |
| MCCAREY INC3 | 6320 GREENHAVEN DRIVE CARLSBAD, CA 92009 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $59 | $22 | $81 | 0.20% |
| MICHAEL F FAHEY III3 Filed as: MICHAEL F FAHEY | 103 PALM DRIVE SAN CLEMENTE, CA 92672 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $52 | — | $52 | 0.13% |
| KIMBERLEY LYNN SCHMALL3 | 9925 NORTH GRANVILLE AVENUE FRESNO, CA 93720 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $47 | — | $47 | 0.12% |
| CHRISTINE A MILLER3 | 715 AVOCET WAY ARROYO GRANDE, CA 93420 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16 | — | $16 | 0.04% |
| MARGARITA ALEJANDRA RAMIREZ3 | 1356 CALLE COLNETT SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | $2 | $10 | 0.02% |
| NIELSEN INSURANCE GROUP INC3 | 4165 EAST THOUSAND OAK BOULEVARD #325 WESTLAKE VILLAGE, CA 91362 | SUN LIFE ASSURANCE COMPANY OF CANADA | $2K | — | $2K | 15.46% |
| ENROLLEASE3 Filed as: DIGITAL INSURANCE INC DBA ONEDIGITA | 200 GALLERIA PARKWAY SE SUITE 1950 ATLANTA, GA 30339 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $146 | $146 | 1.05% |
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 | 70 | 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) | 70 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 53 | $448K |
| Dental(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 114 | $465K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 114 | $18K |
| Life insurance(2 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 114 | $32K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 54 | $40K |
| Long-term disability | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 114 | $18K |
| Other(3 contracts, 3 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 114 | $72K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 114 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.