| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DRIVE SE CALEDONIA, MI 49316 | CALIFORNIACHOICE | $25K | — | $25K | 4.98% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | PO BOX 1788 GRAND RAPIDS, MI 49501 | HEALTH NET | $6K | — | $6K | 4.18% |
| JUDY BERNICE HENRY3 | 19521 POMPANO LANE #108 HUNTINGTON BEACH, CA 92648 | HEALTH NET | $4K | — | $4K | 2.77% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DRIVE SE CALEDONIA, MI 49316 | GUARDIAN | $5K | $4K | $8K | 10.28% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | DBA SHOREPOINT INSURANCE SERVICES COSTA MESA, CA 92626 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 10.36% |
| DAVID O CHRISTENSEN3 | 180 MCKNIGHT DRIVE LAGUNA BEACH, CA 92651 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $656 | $238 | $894 | 7.32% |
| SHERRI BARHAM3 | 24694 PASEO DE TORONTO YORBA LINDA, CA 92887 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $777 | $24 | $801 | 6.56% |
| BRIAN YERVANT AKIAN3 | 503 SPRINGBROOK NORTH IRVINE, CA 92614 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $442 | $63 | $505 | 4.13% |
| MICHAEL F FAHEY III3 | 411 AVENIDA ADOBE SAN CLEMENTE, CA 92672 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $356 | $104 | $460 | 3.77% |
| INOCENCIA MAY CRAWFORD3 | 3055 FOTTHIL BLVD #3 LA CRESCENTA, CA 91214 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $239 | $27 | $266 | 2.18% |
| ERIC TERRAZAS3 | 217 LOIS ST LA HABRA, CA 90631 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $242 | $5 | $247 | 2.02% |
| DAVID A. RACKLIFFE3 Filed as: DAVID A RACKLIFFE | 300 HEROIT CT SPRING HILL, TN 37174 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $163 | $21 | $184 | 1.51% |
| WILLIAM DOUGLAS DEACON3 | 5391 VANGUARD AVE GARDEN GROVE, CA 92845 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $68 | $3 | $71 | 0.58% |
| CALIFORNIA INSURANCE ADVOCATES INC3 | 41960 AVENIDA DE ANITA TEMECULA, CA 92592 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $22 | $7 | $29 | 0.24% |
| DEL DOWNEY3 | 41960 AVENIDA DE ANITA TEMECULA, CA 92592 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $19 | $1 | $20 | 0.16% |
| YOLO ENTERPRISE INC3 | 2581 HILLCREST ST SIGNAL HILL, CA 90755 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | $1 | $6 | 0.05% |
| MARIANNA REBECCA WEAVER3 | 20092 CHAMPLAIN LAKE FOREST, CA 92630 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.04% |
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 | 133 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 133 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIACHOICE | 102 | $640K |
| Dental(2 contracts, 2 carriers) | HEALTH NET | 133 | $218K |
| Vision(2 contracts, 2 carriers) | HEALTH NET | 133 | $218K |
| Life insurance | GUARDIAN | 133 | $79K |
| Other(2 contracts, 2 carriers) | GUARDIAN | 133 | $91K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 133 | — |
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.