| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | BLUE CROSS OF CALIFORNIA | $57K | — | $57K | 5.10% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 2677 N MAIN STREET, STE 800 SANTA ANA, CA 92705 | BLUE CROSS OF CALIFORNIA | — | $22K | $22K | 1.98% |
| AMERICORP FINANCIAL3 Filed as: AMERICORP FINANCIAL PENSION & INSUR | 1964 WESTWOOD BLVD #120 LOS ANGELES, CA 90025 | BLUE CROSS OF CALIFORNIA | $9K | — | $9K | 0.83% |
| ACRISURE LLC3 | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | BLUE CROSS OF CALIFORNIA | — | $2K | $2K | 0.14% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC DBA SHOR | 1120 BRISTOL STREET COSTA MESA, CA 92626 | HUMANA INSURANCE COMPANY | $7K | — | $7K | 11.37% |
| AMERICORP FINANCIAL3 Filed as: AMERICORP FINANCIAL PENSION INSURAN | 1964 WESTWOOD BLVD LOS ANGELES, CA 90025 | HUMANA INSURANCE COMPANY | $2K | — | $2K | 3.62% |
| ACRISURE LLC3 | 100 OTTAWA AVENUE SW GRAND RAPIDS, MI 49503 | HUMANA INSURANCE COMPANY | $715 | — | $715 | 1.11% |
| ENROLL TECH INC3 | 396 CYPRESS DR APT F LAGUNA BEACH, CA 92651 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6K | $4K | $10K | 20.72% |
| MICHAEL F FAHEY III3 | 103 PALM DR SAN CLEMENTE, CA 92672 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $2K | $5K | 10.70% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 4000 WESTERLY PLACE NEWPORT BEACH, CA 92660 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | — | $4K | 8.89% |
| RUBEN RODRIGUEZ BAEZA3 | 10760 DROXFORD ST UNIT 3 CERRITOS, CA 90703 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | — | $3K | 5.14% |
| LUIS ERNESTO PEREZ3 Filed as: LUIS PEREZ BENEFIT INSURANCE SOLUTI | 861 KENWOOD ST UPLAND, CA 91784 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $370 | $2K | 4.41% |
| UZIEL RIVERA3 | 1267 SILVER TORCH DR BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $113 | $1K | 2.50% |
| LUIS RAFAEL VALLE3 | 2354 CHATKA LN SAN BERNARDINO, CA 92410 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 2.21% |
| ERIC ALEXANDER NOVOA3 | 17871 SHADY VIEW DR UNIT 1503 CHINO HILLS, CA 91709 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $919 | $67 | $986 | 2.01% |
| ROSE VILLALON PASQUEL3 | 552 E CARSON ST #104-412 CARSON, CA 90745 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $416 | $9 | $425 | 0.87% |
| LUZ CASTILLO BARRIGA3 | 22019 JUAN AVE HAWAIIAN GARDENS, CA 90716 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $407 | — | $407 | 0.83% |
| SHANNON LEIGH MANN3 | PO BOX 69803 WEST HOLLYWOOD, CA 90069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $399 | — | $399 | 0.82% |
| ALENDY G AGUILAR3 | 12972 SUSANVILLE ST HESPERIA, CA 92344 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $378 | — | $378 | 0.77% |
| KRISTIN LEASE3 | 3890 HOWARD AVE LOS ALAMITOS, CA 90720 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $186 | $165 | $351 | 0.72% |
| JENNIFER NOVOA3 | 17871 SILVER TORCH DR CHINO HILLS, CA 91709 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $333 | — | $333 | 0.68% |
| LILIANA RIVERA3 | 1267 SILVER TORCH DR BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $111 | $6 | $117 | 0.24% |
| GROUP SUPPLEMENTAL BENEFITS INC3 | 39970 STACEY CT MURRIETA, CA 92563 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $31 | $49 | $80 | 0.16% |
| CONSUMER DRIVEN BENEFITS LLC3 | 1772 SUNSET VIEW DR TRABUCO CANYON, CA 92679 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $25 | $43 | $68 | 0.14% |
| JON MALMBORG3 Filed as: JON CURTIS RICHERT | 35925 LEAH LN YUCAIPA, CA 92399 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $31 | $22 | $53 | 0.11% |
| WILLIAM MARC ALVISO3 | 3553 TWOGOOD LN RIVERSIDE, CA 92501 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $25 | $5 | $30 | 0.06% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3 POLARIS WAY, 4TH FLOOR ALISO VIEJO, CA 92656 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $5K | $932 | $6K | 13.86% |
| ACRISURE LLC3 Filed as: ACRISURE SOUTHWEST PARTNERS INSURAN | 100 OTTAWA AVE GRAND RAPIDS, MI 49503 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | — | $932 | $932 | 2.02% |
| AMERICORP FINANCIAL PENSION & INS3 Filed as: AMERICORP FINANCIAL PENSION & INS S | 2549 EASTBLUFF DR NEWPORT BEACH, CA 92660 | AMERICAN FIDELITY ASSURANCE COMPANY | $807 | — | $807 | 3.56% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | P. 0. BOX 25360 OKLAHOMA CITY, OK 73125 | AMERICAN FIDELITY ASSURANCE COMPANY | -$105 | — | -$105 | -0.46% |
| AMERICORP FINANCIAL PENSION & INS3 Filed as: AMERICORP FINANCIAL PENSION & INS S | 2549 EASTBLUFF DR NEWPORT BEACH, CA 92660 | AMERICAN FIDELITY ASSURANCE COMPANY | $572 | — | $572 | 3.71% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | P. 0. BOX 25360 OKLAHOMA CITY, OK 73125 | AMERICAN FIDELITY ASSURANCE COMPANY | -$993 | — | -$993 | -6.44% |
| AMERICORP FINANCIAL PENSION & INS3 | 2549 EASTBLUFF DR NEWPORT BEACH, CA 92660 | AMERICAN FIDELITY ASSURANCE COMPANY | $353 | — | $353 | 3.41% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | P.O. BOX 25360 OKLAHOMA CITY, OK 73125 | AMERICAN FIDELITY ASSURANCE COMPANY | -$205 | — | -$205 | -1.98% |
| AMERICORP FINANCIAL PENSION & INS3 Filed as: AMERICORP FINANCIAL PENSION & INS S | 2549 EASTBLUFF DR NEWPORT BEACH, CA 92660 | AMERICAN FIDELITY ASSURANCE COMPANY | $280 | — | $280 | 3.32% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | P. 0. BOX 25360 OKLAHOMA CITY, OK 73125 | AMERICAN FIDELITY ASSURANCE COMPANY | -$455 | — | -$455 | -5.39% |
| TRIPLE CHOICE PLAN3 | 1964 WESTWOOD BLVD, SUITE 120 LOS ANGELES, CA 90025 | VISION PLAN OF AMERICA | $316 | — | $316 | 14.99% |
| AMERICORP FINANCIAL PENSION & INS3 Filed as: AMERICORP FINANCIAL PENSION & INS S | 2549 EASTBLUFF DR NEWPORT BEACH, CA 92660 | AMERICAN FIDELITY ASSURANCE COMPANY | $18 | — | $18 | 1.17% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | P. 0. BOX 25360 OKLAHOMA CITY, OK 73125 | AMERICAN FIDELITY ASSURANCE COMPANY | -$21 | — | -$21 | -1.36% |
| AMERICORP FINANCIAL PENSION & INS3 Filed as: AMERICORP FINANCIAL PENSION & INS S | 2549 EASTBLUFF DR NEWPORT BEACH, CA 92660 | AMERICAN FIDELITY ASSURANCE COMPANY | $4 | — | $4 | 11.11% |
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 | 237 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 237 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 145 | $1.1M |
| Dental(3 contracts, 3 carriers) | HUMANA INSURANCE COMPANY | 237 | $120K |
| Vision(3 contracts, 3 carriers) | HUMANA INSURANCE COMPANY | 237 | $112K |
| Life insurance(2 contracts, 2 carriers) | HUMANA INSURANCE COMPANY | 237 | $110K |
| Short-term disability | AMERICAN FIDELITY ASSURANCE COMPANY | 69 | $23K |
| Long-term disability | AMERICAN FIDELITY ASSURANCE COMPANY | 17 | $15K |
| Other(7 contracts, 4 carriers) | HUMANA INSURANCE COMPANY | 237 | $180K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 237 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.