| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | UNKNOWN COSTA MESA, CA 92626 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | — | $11K | $11K | 4.44% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 100 NE 3RD AVENUE, SUITE 610 FORT LAUDERDALE, FL 33301 | AETNA LIFE INSURANCE COMPANY | — | $172 | $172 | 0.09% |
| DAVID O CHRISTENSEN3 Filed as: DAVID O. CHRISTENSEN | 180 MCKNIGHT DRIVE LAGUNA BEACH, CA 92651 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $11K | $1K | $12K | 15.92% |
| UZIEL RIVERA3 Filed as: UZIEL RIVERA AND OTHER AGENTS | 543 CHEROKEE DRIVE BANNING, CA 92220 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $400 | $3K | 3.79% |
| MICHAEL F FAHEY III3 Filed as: MICHAEL F. FAHEY III | 411 AVENIDA ADOBE SAN CLEMENTE, CA 92672 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $894 | $3K | 3.26% |
| MARGARITA ALEJANDRA RAMIREZ3 | 1356 CALLE COLNETT SAN MARCOS, CA 92069 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $923 | $312 | $1K | 1.59% |
| MICHAEL MENDOZA3 | 18543 YORBA LINDA BOULEVARD YORBA LINDA, CA 92886 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $936 | — | $936 | 1.21% |
| ETHAN ISRAEL CRUZ3 | 3800 WEST DEVONSHIRE AVENUE HEMET, CA 92545 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $663 | $103 | $766 | 0.99% |
| ERIC TERRAZAS3 | 217 LOIS STREET LA HABRA, CA 90631 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $629 | $12 | $641 | 0.83% |
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 | 310 | 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) | 310 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | AETNA HEALTH OF CALIFORNIA, INC. | 239 | $2.3M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 310 | $243K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 310 | $243K |
| Life insurance(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 310 | $321K |
| Short-term disability | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 3 | $78K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 310 | $243K |
| Prescription drug(3 contracts, 3 carriers) | AETNA HEALTH OF CALIFORNIA, INC. | 239 | $2.2M |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 310 | $321K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 310 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.