| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 1120 BRISTOL ST. COSTA MESA, CA 92626 | BLUE SHIELD OF CALIFORNIA | — | $57K | $57K | 5.38% |
| AMWINS3 Filed as: LISI, INC | 1600 W HILLSDALE BLVD SUITE 201 SAN MATEO, CA 94402 | BLUE SHIELD OF CALIFORNIA | — | $23K | $23K | 2.11% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $7K | $4K | $10K | 10.31% |
| ENROLLEASE3 | 660 YORK STREET SUITE 102 SAN FRANCISCO, CA 94110 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 2.97% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | DBA SHOREPOINT INSURANCE SERVI COSTA MESA, CA 92626 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7K | $823 | $7K | 11.67% |
| DAVID O CHRISTENSEN3 | 180 MCKNIGHT DRIVE LAGUNA BEACH, CA 92651 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $670 | $3K | 5.07% |
| MICHAEL F FAHEY III3 | 9301 NW 33RD ST DORAL, FL 33172 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $503 | $2K | 2.62% |
| BRIAN YERVANT AKIAN3 | 503 SPRINGBROOK NORTH IRVINE, CA 92614 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $98 | $1K | 2.16% |
| LUIS RAFAEL VALLE3 | 2354 CHATKA LANE SAN BERNARDINO, CA 92410 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $620 | $27 | $647 | 1.02% |
| JIMMY CHUON TCHEN3 | 15904 KENNARD STREET HACIENDA HEIGHTS, CA 91745 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $436 | $186 | $622 | 0.98% |
| MARGARITA ALEJANDRA RAMIREZ3 | 1356 CALLE COLNETT SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $401 | $57 | $458 | 0.72% |
| LUZ CASTILLO BARRIGA3 | 22019 JUAN AVE HAWAIIAN GARDENS, CA 90716 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $393 | — | $393 | 0.62% |
| MELISSA MARIE MARTINO3 | 15904 KENNARD ST HACIENDA HEIGHTS, CA 91745 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $261 | — | $261 | 0.41% |
| MARIA YVONNE RODIGHIERO3 | 28502 SHRIKE DRIVE LAGUNA NIGUEL, CA 92677 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $162 | $21 | $183 | 0.29% |
| YVETTE KORINA HERNANDEZ3 | 1208 WHITTIER AVE BREA, CA 92821 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $151 | $22 | $173 | 0.27% |
| THEINTHANH DANG3 | 1587 W CRONE AVE ANAHEIM, CA 92802 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $172 | — | $172 | 0.27% |
| LIFE TIME SOLUTIONS LLC3 | 861 KENWOOD ST UPLAND, CA 91784 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $137 | $21 | $158 | 0.25% |
| CHAU PHAN3 | 6 FOREST IRVINE, CA 92612 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $153 | — | $153 | 0.24% |
| ERIC ALEXANDER NOVOA3 | 17871 SHADY VIEW DR CHINO HILLS, CA 91709 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $133 | $13 | $146 | 0.23% |
| JOHN D EVANGELISTA3 | 26111 ANTONIO PARKWAY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $36 | $87 | $123 | 0.19% |
| YOLO ENTERPRISE INC3 | 5460 E EL PRAQUE ST LONG BEACH, CA 90815 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $108 | $12 | $120 | 0.19% |
| DEBORAH RUSH KIMMONS3 | 37291 BOSLEY ST INDIO, CA 92203 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $95 | — | $95 | 0.15% |
| CARMEN SANDERS3 | 2109 ABRAZO DR WEST COVINA, CA 91791 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $92 | — | $92 | 0.15% |
| NICHOLAS RYAN DERRICO3 | 1745 W ORANGEWOOD AVE STE 212 ORANGE, CA 92868 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $42 | $37 | $79 | 0.12% |
| UZIEL RIVERA3 | 1267 SILVER TORCH DRIVE BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $75 | — | $75 | 0.12% |
| ANTIONETTE MARI GARCIA3 | 1745 ORANGEWOOD AVE #212 ORANGE, CA 92868 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $42 | $24 | $66 | 0.10% |
| GOLD RIVER FINANCIAL GROUP LLC3 | 2807 GRATTON ST RIVERSIDE, CA 92504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $54 | — | $54 | 0.09% |
| OTILIA RAMIREZ3 | 13265 RIVER OAKS DR RANCHO CUCAMONGA, CA 91739 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $30 | — | $30 | 0.05% |
| MANDY ELIZABETH SIMON3 | 4900 PLANET CT LAS VEGAS, NV 89130 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $22 | — | $22 | 0.03% |
| CONSUMER DRIVEN BENEFITS LLC3 | 3737 BIRCH ST NEWPORT BEACH, CA 92660 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | $9 | $21 | 0.03% |
| TINA HERNANDEZ3 | 11779 W COCOPAH ST AVONDALE, AZ 85323 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | — | $12 | 0.02% |
| JENNIFER AURORA RAMIREZ3 | 1053 FICUS LANE SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | $1 | $10 | 0.02% |
| MARIANNA REBECCA WEAVER3 | 20092 CHAMPLAIN LAKE FOREST, CA 92630 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.01% |
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 | 168 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 168 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE SHIELD OF CALIFORNIA | 189 | $1.1M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 169 | $99K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 169 | $99K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 169 | $99K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 169 | $99K |
| Prescription drug | BLUE SHIELD OF CALIFORNIA | 189 | $1.1M |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 169 | $162K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 189 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
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.