| 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 | — | $53K | $53K | 5.29% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SVCS LLC | 1600 W HILLSDALE BLVD SUITE 201 SAN MATEO, CA 94402 | BLUE SHIELD OF CALIFORNIA | — | $21K | $21K | 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 | $6K | $8K | $14K | 17.15% |
| ENROLLEASE3 | 660 YORK STREET SUITE 102 SAN FRANCISCO, CA 94110 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 2.18% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | DBA SHOREPOINT INSURANCE SVCS COSTA MESA, CA 92626 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5K | $53 | $5K | 10.30% |
| DAVID O CHRISTENSEN3 | 180 MCKNIGHT DRIVE LAGUNA BEACH, CA 92651 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $369 | $2K | 3.70% |
| MICHAEL F FAHEY III3 | 9301 NW 33RD ST DORAL, FL 33172 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $646 | $98 | $744 | 1.47% |
| JB CREATIVE SOLUTIONS LLC3 | 3881 FREEMAN WAY PROSPER, TX 75078 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $468 | $41 | $509 | 1.00% |
| JIMMY CHUON TCHEN3 | 15904 KENNARD STREET HACIENDA HEIGHTS, CA 91745 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $209 | $156 | $365 | 0.72% |
| CORNER BEAR INC3 | 15904 KENNARD STREET HACIENDA HEIGHTS, CA 91745 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $248 | $78 | $326 | 0.64% |
| LUIS RAFAEL VALLE3 | 2354 CHATKA LANE SAN BERNARDINO, CA 92410 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $203 | $18 | $221 | 0.44% |
| MARGARITA ALEJANDRA RAMIREZ3 | 1356 CALLE COLNETT SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $205 | — | $205 | 0.40% |
| BRIAN YERVANT AKIAN3 | PO BOX 17269 IRVINE, CA 92623 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $183 | — | $183 | 0.36% |
| JOHN D EVANGELISTA3 | 151 LAS FLORES ALISO VIEJO, CA 92656 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $58 | $39 | $97 | 0.19% |
| UZIEL RIVERA3 | 1267 SILVER TORCH DRIVE BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $66 | — | $66 | 0.13% |
| ERIC ALEXANDER NOVOA3 | 17871 SHADY VIEW DR CHINO HILLS, CA 91709 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $61 | — | $61 | 0.12% |
| MARIA YVONNE RODIGHIERO3 | 28502 SHRIKE DRIVE LAGUNA NIGUEL, CA 92677 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $49 | — | $49 | 0.10% |
| LUZ CASTILLO BARRIGA3 | 22019 JUAN AVE HAWAIIAN GARDENS, CA 90716 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $41 | — | $41 | 0.08% |
| CHAU PHAN3 | 6 FOREST IRVINE, CA 92612 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $39 | — | $39 | 0.08% |
| GOLD RIVER FINANCIAL GROUP LLC3 | 2807 GRATTON ST RIVERSIDE, CA 92504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $33 | — | $33 | 0.06% |
| MELISSA MARIE MARTINO3 | 15904 KENNARD ST HACIENDA HEIGHTS, CA 91745 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $27 | — | $27 | 0.05% |
| DEBORAH RUSH KIMMONS3 | 37291 BOSLEY ST INDIO, CA 92203 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $23 | $4 | $27 | 0.05% |
| LUIS RAFAEL VALLE3 Filed as: LUIS PEREZ BENEFIT INS SOLUTIONS | 861 KENWOOD ST UPLAND, CA 91784 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $24 | — | $24 | 0.05% |
| THEINTHANH DANG3 | 1587 W CRONE AVE ANAHEIM, CA 92802 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $23 | — | $23 | 0.05% |
| YVETTE KORINA HERNANDEZ3 | 1208 WHITTIER AVE BREA, CA 92821 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $19 | — | $19 | 0.04% |
| YOLO ENTERPRISE INC3 Filed as: YOLO ENTERPRISES INC | 5460 E EL PRAQUE ST LONG BEACH, CA 90815 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $14 | — | $14 | 0.03% |
| LIFE TIME SOLUTIONS LLC3 | 861 KENWOOD ST UPLAND, CA 91784 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $13 | — | $13 | 0.03% |
| NICHOLAS RYAN DERRICO3 | 1745 W ORANGEWOOD AVE STE 212 ORANGE, CA 92868 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.01% |
| ANTIONETTE MARI GARCIA3 | 1745 ORANGEWOOD AVE, 212 ORANGE, CA 92504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.01% |
| MARIANNA REBECCA WEAVER3 | 20092 CHAMPLAIN LAKE FOREST, CA 92630 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 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 | 173 | $993K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 152 | $79K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 152 | $79K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 152 | $79K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 152 | $79K |
| Prescription drug | BLUE SHIELD OF CALIFORNIA | 173 | $993K |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 152 | $130K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 173 | — |
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.