| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR CALEDONIA, MI 49316 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $41K | — | $41K | 8.17% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | DBA SHOREPOINT INSURANCE SERVICE COSTA MESA, CA 92626 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 12.50% |
| DAVID O CHRISTENSEN3 | 180 MCKNIGHT DRIVE LAGUNA BEACH, CA 92651 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $828 | $430 | $1K | 11.71% |
| MICHAEL F FAHEY III3 Filed as: MICHAEL F FAHEY | 411 AVENIDA ADOBE SAN CLEMENTE, CA 92672 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $802 | $57 | $859 | 8.00% |
| MARGARITA ALEJANDRA RAMIREZ3 | 1356 CALLE COLNETT SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $562 | $247 | $809 | 7.53% |
| BRIAN YERVANT AKIAN3 | 503 SPRINGBROOK NORTH IRVINE, CA 92614 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $520 | $133 | $653 | 6.08% |
| ERIC ALEXANDER NOVOA3 | 17871 SHADY VIEW DR CHINO HILLS, CA 91709 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $362 | $100 | $462 | 4.30% |
| UZIEL RIVERA3 | 1267 SILVER TORCH DRIVE BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $312 | $150 | $462 | 4.30% |
| GOLD RIVER FINANCIAL GROUP LLC3 | 2807 GRATTON ST RIVERSIDE, CA 92504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $277 | $154 | $431 | 4.01% |
| THIENTHANH DANG3 | 1587 W CRONE AVE ANAHEIM, CA 92802 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $98 | — | $98 | 0.91% |
| CONSUMER DRIVEN BENEFITS LLC3 | 3737 BIRCH ST NEWPORT BEACH, CA 92660 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $27 | $69 | $96 | 0.89% |
| JOHN D EVANGELISTA3 | 26111 ANTONIO PARKWAY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $47 | $18 | $65 | 0.61% |
| JEAN CHRISTOPHER TRAN3 | 3311 W LINCOLN AVE ANAHEIM, CA 92801 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $62 | — | $62 | 0.58% |
| TINA HERNANDEZ3 | 11779 W COCOPAH ST AVONDALE, AZ 85323 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $27 | $21 | $48 | 0.45% |
| TIM CHRISTOPHER ELLIS3 | PO BOX 483 ORANGE, CA 92856 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $43 | — | $43 | 0.40% |
| MARIANNA REBECCA WEAVER3 | 20092 CHAMPLAIN LAKE FOREST, CA 92630 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | — | $8 | 0.07% |
| YOLO ENTERPRISE INC3 Filed as: YOLO ENTERPIRSE INC | 5460 E EL PRAQUE ST LONG BEACH, CA 90815 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | $1 | $2 | 0.02% |
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 | 154 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 155 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 154 | $502K |
| Dental | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 154 | $502K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 154 | $502K |
| Life insurance | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 154 | $502K |
| Other | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 70 | $11K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 154 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.