| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| OLSON, TIMOTHY H3 Filed as: OLSON DUNCAN INSURANCE | — | CALIFORNIA CHOICE | $63K | — | $63K | 4.75% |
| ERIK A MIKKELSEN3 | — | CALIFORNIA CHOICE | $3K | — | $3K | 0.22% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INSURANCE & FINANCIAL S | — | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $4K | — | $4K | 5.00% |
| ERIK A MIKKELSEN3 | — | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $4K | — | $4K | 5.00% |
| OLSON DUNCAN INSURANCE SERVICES INC3 Filed as: OLSON DUNCAN INSURANCE SERVICE INC | — | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $4K | — | $4K | 5.00% |
| OLSON DUNCAN INSURANCE SERVICES INC3 Filed as: OLSON DUNCAN INS SERVICE INC | STE 203 25550 HAWTHORNE BLVD TORRANCE, CA 90505 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 10.12% |
| ERIK A MIKKELSEN3 | 25500 HAWTHORNE BLVD STE 1140 TORRANCE, CA 90505 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $559 | — | $559 | 0.80% |
| OLSON DUNCAN INSURANCE SERVICES INC3 Filed as: OLSON DUNCAN INS SERVICE INC | STE 203 25550 HAWTHORNE BLVD TORRANCE, CA 90505 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 16.74% |
| ERIK A MIKKELSEN3 | 25500 HAWTHORNE BLVD STE 1140 TORRANCE, CA 90505 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $51 | — | $51 | 0.52% |
| OLSON DUNCAN INSURANCE SERVICES INC3 Filed as: OLSON DUNCAN INSURANCE SERVICE INC | 25550 HAWTHORNE BL #203 TORRANCE, CA 90505 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $4K | — | $4K | 54.01% |
| CENTERSTONE INSURANCE AND FINANCIAL3 | SERVICES 12404 PARK CENTRAL DR SUITE 400S DALLAS, TX 75251 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | — | $2K | $2K | 29.40% |
| ERIK A MIKKELSEN3 Filed as: ERIK MIKKELSEN | 25500 HAWTHORNE BL #1140 TORRANCE, CA 90505 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $331 | — | $331 | 4.81% |
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 | 180 | 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) | 180 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA CHOICE | 141 | $1.3M |
| Dental(2 contracts) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 179 | $77K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 179 | $7K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 180 | $80K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 180 | $70K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 180 | $70K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 180 | $80K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 180 | — |
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.