| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | 8110 E. UNION SUITE 700 DENVER, CO 80237 | BLUE CROSS OF CALIFORNIA | $30K | — | $30K | 14.17% |
| ROGERS BENEFIT GROUP INC3 Filed as: ROGERS BENEFIT GROUP INC. | 80 S. 8TH ST. SUITE 4628 MINNEAPOLIS, MN 55402 | BLUE CROSS OF CALIFORNIA | — | $11K | $11K | 5.02% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | BLUE CROSS OF CALIFORNIA | $8K | — | $8K | 3.79% |
| DANIEL TYLER ADAMSON3 | 405 S. HIBISCUS WAY ANAHEIM, CA 92808 | CONTINENTAL AMERICAN INSURANCE COMPANY | $916 | — | $916 | 6.88% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | 725 S. FIGUEROA ST. 35TH FLOOR LOS ANGELES, CA 90017 | CONTINENTAL AMERICAN INSURANCE COMPANY | $864 | — | $864 | 6.49% |
| JONATHAN ALI HAJIMOMEN3 Filed as: JONATHAN HAJIMOMEN | 1501 ORNAGETHORPE SUITE 108 FULLERTON, CA 90620 | CONTINENTAL AMERICAN INSURANCE COMPANY | $116 | — | $116 | 0.87% |
| DANIEL TYLER ADAMSON3 | 2700 N. MAIN ST. SUITE 945 SANTA ANA, CA 92705 | CONTINENTAL AMERICAN INSURANCE COMPANY | $67 | — | $67 | 0.50% |
| JANICE M ADAMSON3 Filed as: JANICE M. ADAMSON | 405 S. HIBISCUS WAY ANAHEIM, CA 928081639 | CONTINENTAL AMERICAN INSURANCE COMPANY | $58 | — | $58 | 0.44% |
| JULIE L WOLD3 Filed as: JULIE L. WOLD | 7720 E. MOONRIDGE LANE ANAHEIM HILLS, CA 928081514 | CONTINENTAL AMERICAN INSURANCE COMPANY | $42 | — | $42 | 0.32% |
| GINA L GAXIOLA3 Filed as: GINA L. GAXIOLA | 730 MANDEVILLA WAY CORONA, CA 92879 | CONTINENTAL AMERICAN INSURANCE COMPANY | $16 | — | $16 | 0.12% |
| ARTHUR LEYVAS3 | 495 E. RINCON ST. SUITE 212 CORONA, CA 92879 | CONTINENTAL AMERICAN INSURANCE COMPANY | $7 | — | $7 | 0.05% |
| FELIX CORTES3 | 810 25TH ST. SUITE 2409 OGDEN, UT 84401 | CONTINENTAL AMERICAN INSURANCE COMPANY | $4 | — | $4 | 0.03% |
| MJ INSURANCE3 Filed as: CLAUDIA E. DONOFRIO | 11140 LOS ALAMITOS BLVD. SUITE 201 LOS ALAMITOS, CA 90720 | CONTINENTAL AMERICAN INSURANCE COMPANY | $2 | — | $2 | 0.02% |
| JASON DAVIS INSURANCE SERVICES INC3 Filed as: JASON DAVIS INSURANCE | SERVICES INC. 10571 CALLE LEE, SUITE 171 LOS ALAMITOS, CA 90720 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1 | — | $1 | 0.01% |
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 | 282 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 284 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 282 | $214K |
| Dental | BLUE CROSS OF CALIFORNIA | 282 | $214K |
| Vision | BLUE CROSS OF CALIFORNIA | 282 | $214K |
| Life insurance | BLUE CROSS OF CALIFORNIA | 282 | $214K |
| Short-term disability | CONTINENTAL AMERICAN INSURANCE COMPANY | 295 | $13K |
| Long-term disability | BLUE CROSS OF CALIFORNIA | 282 | $214K |
| Other(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 295 | $228K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 295 | — |
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.