| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CHUN-HA INSURANCE SERVICES, INC.3 Filed as: CHUN HA INSURANCE SERVICES INC. | 9122 GARDEN GROVE BLVD GARDEN GROVE, CA 92844 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | $9K | — | $9K | 6.55% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 18201 VON KARMAN AVE, SUITE 200 IRVINE, CA 92612 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | $5K | — | $5K | 3.37% |
| PEGGY K SALMON3 | 2203 AVENIDA OLIVA SAN CLEMENTE, CA 92673 | AFLAC | $2K | $322 | $3K | 7.24% |
| ANDY JOSE CASTRO3 | 20 CATHERINE SLIP APT 6C NEW YORK, NY 10038 | AFLAC | $2K | $521 | $2K | 6.15% |
| JANELLE MARIE GADOMSKI3 | 166 MIDLAND AVE YONKERS, NY 10705 | AFLAC | $486 | $27 | $513 | 1.41% |
| STEPHANIE A REYNOSO3 | 21 CERVANTES NEWPORT BEACH, CA 92660 | AFLAC | $366 | $55 | $421 | 1.16% |
| PATRICK RUHLE3 Filed as: PATRICK C HARDIE | 14 WALL ST STE 8C NEW YORK, NY 10005 | AFLAC | $298 | $27 | $325 | 0.89% |
| KORNELIJA NUMIC3 | 25201 PASEO DE ALICIA STE 210 LAGUNA HILLS, CA 92653 | AFLAC | $274 | — | $274 | 0.75% |
| ZORN BENEFITS GROUP LLC3 | 179 S GLEN RD KINNELON, NJ 07405 | AFLAC | $173 | — | $173 | 0.48% |
| FRANK GRANITO3 | PO BOX 170 BLAIRSTOWN, NJ 07825 | AFLAC | $155 | — | $155 | 0.43% |
| OWEN JOHNSTON3 Filed as: OWEN C JOHNSTON | 796 N HART ST ORANGE, CA 92867 | AFLAC | $140 | — | $140 | 0.38% |
| DEBBIE SCHULTZ3 | 2384 VIA MARIPOSA W UNIT 3F LAGUNA WOODS, CA 92637 | AFLAC | $79 | $51 | $130 | 0.36% |
| MICHAEL A FORNARO3 | 271 US HIGHWAY 46 STE H119 FAIRFIELD, NJ 07004 | AFLAC | $91 | — | $91 | 0.25% |
| CLINT D SALMON3 | 35 DOWNFIELD WAY TRABUCO CANYON, CA 92679 | AFLAC | $71 | — | $71 | 0.20% |
| MIRIAM F HUNGERFORD3 | 33622 HOLTZ HILL RD DANA POINT, CA 92629 | AFLAC | $54 | — | $54 | 0.15% |
| KIMBERLY FERGUSON3 Filed as: KIMBERLY SANKA | 861 VOORHEES AVE MIDDLESEX, NJ 08846 | AFLAC | $46 | — | $46 | 0.13% |
| ALBERT SHUST3 | 200 CENTENNIAL AVE STE 105 PISCATAWAY, NJ 08854 | AFLAC | $42 | — | $42 | 0.12% |
| ANDREW R GRETHEL3 | 11739 HICKORY RUN CT LOVELAND, OH 45140 | AFLAC | $15 | — | $15 | 0.04% |
| WORTHAM SAN ANTONIO INC3 Filed as: JOHN A PITUCH | PO BOX 335 SPARTA, NJ 07871 | AFLAC | $13 | — | $13 | 0.04% |
| BARRY MCPHERSON INC3 | 2211 MICHELSON DR STE 1150 IRVINE, CA 92612 | AFLAC | $5 | — | $5 | 0.01% |
| JAMES J GRETHEL3 | 865 CEDAR DR LOVELAND, OH 45140 | AFLAC | $4 | — | $4 | 0.01% |
| KERSTIN J VANZANTEN3 | 40152 STOWE RD TEMECULA, CA 92591 | AFLAC | $4 | — | $4 | 0.01% |
| OWEN JOHNSTON3 | 796 N HART ST ORANGE CA, CA 92867 | AFLAC | $3 | — | $3 | 0.01% |
| TARA MICHELLE D AGOSTINO3 | 87A BOORAEM AVE JERSEY CITY, NJ 07307 | AFLAC | $2 | — | $2 | 0.01% |
| DALE I DAVIS3 | 5892 CEDARCREEK LN LEXINGTON, KY 40515 | AFLAC | $2 | — | $2 | 0.01% |
| DALE I DAVIS3 | 1856 TRAVELLER RD LEXINGTON, KY 40504 | AFLAC | $1 | — | $1 | 0.00% |
| CHUN-HA INSURANCE SERVICES, INC.3 Filed as: THE CHUN HA AGENCY | 9122 GARDEN GROVE BLVD GARDEN GROVE, CA 92844 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 7.41% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 18201 VON KARMAN AVENUE STE 200 IRVINE, CA 92612 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $384 | — | $384 | 1.91% |
| CHUN-HA INSURANCE SERVICES, INC.3 Filed as: THE CHUN HA AGENCY | 9122 GARDEN GROVE BLVD GARDEN GROVE, CA 92844 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $583 | — | $583 | 7.41% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 18201 VON KARMAN AVENUE STE 200 IRVINE, CA 92612 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $203 | — | $203 | 2.58% |
| CHUN-HA INSURANCE SERVICES, INC.3 Filed as: THE CHUN HA AGENCY | 9122 GARDEN GROVE BLVD GARDEN GROVE, CA 92844 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $126 | — | $126 | 7.45% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICE | 18201 VON KARMAN AVENUE STE 200 IRVINE, CA 92612 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $44 | — | $44 | 2.60% |
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 | 140 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 144 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 144 | $140K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 144 | $140K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 144 | $8K |
| Short-term disability | AFLAC | 42 | $36K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 144 | $20K |
| Other(2 contracts, 2 carriers) | AFLAC | 144 | $38K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 144 | — |
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.