| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $9K | $5K | $14K | 14.09% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 1120 BRISTOL STREET COSTA MESA, CA 92626 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $875 | — | $875 | 0.91% |
| DAVID O CHRISTENSEN3 | 180 MCKNIGHT DRIVE LAGUNA BEACH, CA 92651 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6K | $544 | $6K | 9.22% |
| USI INSURANCE SERVICES LLC3 | 21700 OXNARD STREET SUITE 1200 WOODLAND HILLS, CA 91367 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $71 | $2K | 2.28% |
| MICHAEL F FAHEY III3 Filed as: MICHAEL F FAHEY | 411 AVENIDA ADOBE SAN CLEMENTE, CA 92672 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $282 | $1K | 1.92% |
| JUSTIN INGLE3 | 26661 VIA SACRAMENTO CAPISTRANO BEACH, CA 92624 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $960 | $244 | $1K | 1.80% |
| BRIAN YERVANT AKIAN3 | 503 SPRINGBROOK NORTH IRVINE, CA 92614 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $777 | $231 | $1K | 1.50% |
| ARIAN E NAWABI3 | 201 DARLINGTON IRVINE, CA 92620 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $722 | $75 | $797 | 1.19% |
| CONSUMER DRIVEN BENEFITS LLC3 | 3737 BIRCH STREET NEWPORT BEACH, CA 92660 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $157 | $176 | $333 | 0.50% |
| EUNICE AKIAN3 | 15551 WILD PLUM CIRCLE HUNTINGTON BEACH, CA 92647 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $268 | — | $268 | 0.40% |
| CURTIS ALBERTO CANETT3 | 21901 HUBETES MISSION VIEJO, CA 92691 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $224 | $25 | $249 | 0.37% |
| MARIA YVONNE RODIGHIERO3 | 28502 SHRIKE DRIVE LAGUNA NIGUEL, CA 92677 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $194 | $29 | $223 | 0.33% |
| MARGARITA ALEJANDRA RAMIREZ3 | 1356 CALLE COLNETT SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $145 | $27 | $172 | 0.26% |
| ERIC TERRAZAS3 | 217 LOIS STREET LA HABRA, CA 90631 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $143 | $2 | $145 | 0.22% |
| ELTHON ISRAEL CRUZ3 | 3800 WEST DEVONSHIRE AVENUE HEMET, CA 92545 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $128 | $14 | $142 | 0.21% |
| GOLD RIVER FINANCIAL GROUP LLC3 | 2807 GRATTON STREET RIVERSIDE, CA 92504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $132 | — | $132 | 0.20% |
| MICHAEL MENDOZA3 | 18543 YORBA LINDA BLVD YORBA LINDA, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $112 | — | $112 | 0.17% |
| SHANIKA M. FISKE3 Filed as: SHANIKA M FISKE | 15 TUOLUMNE WAY ALISO VIEJO, CA 92656 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $74 | $32 | $106 | 0.16% |
| LAMBERT MONTALBO3 | 26197 MIRADA STREET HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $102 | — | $102 | 0.15% |
| LIFE TIME SOLUTIONS LLC3 | 861 KENWOOD STREET UPLAND, CA 91784 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $97 | — | $97 | 0.14% |
| UZIEL RIVERA3 | 1267 SILVER TORCH DRIVE BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $95 | — | $95 | 0.14% |
| VALOR BENEFITS3 | 12125 KOUDEKERK STREET ARTESIA, CA 90701 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $72 | $4 | $76 | 0.11% |
| JAMES E. MCCLEMENTS, JR.3 Filed as: JAMES TUCKER CHRISTENSEN | 180 MCKNIGHT DRIVE APT #4 LAGUNA BEACH, CA 92651 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $62 | — | $62 | 0.09% |
| JACQUELINE RANGEL3 | 1301 DOVE STREET NEWPORT BEACH, CA 92660 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $38 | — | $38 | 0.06% |
| CALIFORNIA INSURANCE ADVOCATES INC3 | 41960 AVENIDA DE ANITA TEMECULA, CA 92592 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $23 | $8 | $31 | 0.05% |
| RACHAEL DARLENE DUBE3 | 1 PEBBLEWOOD IRVINE, CA 92604 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $11 | $5 | $16 | 0.02% |
| SHERRI BARHAM3 | 24694 PASEO DE TORONTO YORBA LINDA, CA 92887 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | — | $12 | 0.02% |
| MARIANNA REBECCA WEAVER3 | 1301 DOVE STREET NEWPORT BEACH, CA 92660 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | $1 | $7 | 0.01% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE | 38 DISCOVERY SUITE 250 IRVINE, CA 91618 | EYE MED | $3K | — | $3K | 12.39% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC DBA | SHOREPOINT INSURANCE 1120 BRISTOL STREET COSTA MESA, CA 92618 | EYE MED | $559 | — | $559 | 2.61% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | — | $2K | 13.40% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 1120 BRISTOL STREET COSTA MESA, CA 92626 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $191 | — | $191 | 1.60% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 BIRGINIA BEACH, VA 23466 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $373 | — | $373 | 13.56% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 1120 BRISTOL STREET COSTA MESA, CA 92626 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $39 | — | $39 | 1.42% |
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 | 244 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 12 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 262 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | AETNA HEALTH, INC | 246 | $1.9M |
| Dental(2 contracts) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 110 | $126K |
| Vision | EYE MED | 325 | $21K |
| Life insurance(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 244 | $70K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 96 | $67K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 243 | $12K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 135 | $585K |
| Other(3 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 244 | $82K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 325 | — |
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.