| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $11K | $10K | $21K | 12.30% |
| ENROLLEASE3 | 660 YORK STREET SUITE 102 SAN FRANCISCO, CA 94110 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 2.18% |
| MPART BENEFITS INC3 | 4621 GLEN HEATHER DRIVE FRISCO, TX 75034 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $14K | $2K | $16K | 17.32% |
| DAVID O CHRISTENSEN3 | 180 MCKNIGHT DRIVE LAGUNA BEACH, CA 92651 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $956 | $5K | 5.85% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | DBA SHOREPOINT INSURANCE SVCS COSTA MESA, CA 92626 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5K | $370 | $5K | 5.59% |
| MICHAEL F FAHEY III3 Filed as: MICHAEL F FAHEY LLC | 9301 33RD ST NW DORAL, FL 33172 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $413 | $2K | 1.69% |
| BRIAN YERVANT AKIAN3 | PO BOX 17269 IRVINE, CA 92623 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $966 | $56 | $1K | 1.10% |
| USI INSURANCE SERVICES LLC3 | 21700 OXNARD ST SUITE 1200 WOODLAND HILLS, CA 91367 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $716 | — | $716 | 0.77% |
| MARGARITA ALEJANDRA RAMIREZ3 | 1356 CALLE COLNETT SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $484 | $126 | $610 | 0.65% |
| GOLD RIVER FINANCIAL GROUP LLC3 | 2807 GRATTON ST RIVERSIDE, CA 92504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $302 | $61 | $363 | 0.39% |
| JOHANA HERMILA MEDINA3 | 13265 RIVER OAKS DR RANCHO CUCAMONGA, CA 91739 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $323 | — | $323 | 0.35% |
| MARIA YVONNE RODIGHIERO3 Filed as: MARIA YVONEE RODIGHIERO | 28502 SHRIKE DRIVE LAGUNA NIGUEL, CA 92677 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $227 | $31 | $258 | 0.28% |
| ERIC ALEXANDER NOVOA3 | 17871 SHADY VIEW DR CHINO HILLS, CA 91709 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $129 | $30 | $159 | 0.17% |
| UZIEL RIVERA3 | 1267 SILVER TORCH DRIVE BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $125 | — | $125 | 0.13% |
| ELTHON ISRAEL CRUZ3 | 893 SOUTH 2100 WEST OREN, UT 84059 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $70 | — | $70 | 0.08% |
| JUSTIN ALEXANDER INGLE3 | 26661 VIA SACRAMENTO CAPISTRANO BEACH, CA 92624 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $46 | — | $46 | 0.05% |
| LIFE TIME SOLUTIONS LLC3 | 861 KENWOOD ST UPLAND, CA 91784 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $39 | — | $39 | 0.04% |
| CONSUMER DRIVEN BENEFITS LLC3 | 1301 DOVE ST NEWPORT BEACH, CA 92660 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $21 | $16 | $37 | 0.04% |
| LAMBERT MONTALBO3 | 26197 MIRADA ST HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $34 | — | $34 | 0.04% |
| ARIAN E NAWABI3 | 201 DARLINGTON IRVINE, CA 92620 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $31 | — | $31 | 0.03% |
| JENNIFER AURORA RAMIREZ3 Filed as: JENNIFER AUTOTA RAMIREZ | 1053 FICUS LANE SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $23 | $1 | $24 | 0.03% |
| TINA HERNANDEZ3 | 11779 W COCOPAH ST AVONDALE, AZ 85323 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $21 | — | $21 | 0.02% |
| CARMEN SANDERS3 | 2109 ABRAZO DR WEST COVINA, CA 91791 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16 | — | $16 | 0.02% |
| DEL DOWNEY3 | 32056 MERLOT CRST TEMECULA, CA 92591 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | DBA SHOREPOINT INSURANCE SVCS COSTA MESA, CA 92626 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $379 | $18 | $397 | 6.53% |
| DAVID O CHRISTENSEN3 | 180 MCKNIGHT DRIVE LAGUNA BEACH, CA 92651 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $325 | $44 | $369 | 6.07% |
| MICHALE F FAHEY II3 | 9301 33RD ST NW DORAL, FL 33172 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $70 | $17 | $87 | 1.43% |
| MITCHELL HECTOR MORALES3 | 4679 SCORE CT SNELLVILLE, GA 30039 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $55 | $8 | $63 | 1.04% |
| ERIC ALEXANDER NOVOA3 | 17871 SHADY VIEW DR CHINO HILLS, CA 91709 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $36 | — | $36 | 0.59% |
| BRIAN YERVANT AKIAN3 | PO BOX 17269 IRVINE, CA 92623 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16 | — | $16 | 0.26% |
| CHARLES AUGUSTUS RAY3 | 12010 BROOKFIELD CLUB RD ROSWELL, GA 30075 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | $2 | $9 | 0.15% |
| COLONIAL LIFE BROKERAGE LLC3 | 12010 BROOKFIELD CLUB RD ROSWELL, GA 30075 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.03% |
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 | 206 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 10 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 216 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | AETNA HEALTH, INC. | 209 | $1.9M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 206 | $173K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 206 | $173K |
| Life insurance(3 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 206 | $272K |
| Short-term disability(2 contracts) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 120 | $99K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 206 | $173K |
| Other(3 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 206 | $272K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 209 | — |
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."
No prospect flags tripped on this filing.