| 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 | CALIFORNIACHOICE | $27K | — | $27K | 5.02% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | CALIFORNIACHOICE | $10K | — | $10K | 5.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | GUARDIAN | $5K | $5K | $10K | 9.86% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | DBA SHOREPOINT INSURANCE SERVICES COSTA MESA, CA 92626 | COLONIAL LIFE | $5K | $660 | $5K | 11.99% |
| DAVID O CHRISTENSEN3 | 180 MCKNIGHT DRIVE LAGUNA BEACH, CA 92651 | COLONIAL LIFE | $3K | $697 | $4K | 8.32% |
| MICHAEL F FAHEY III3 Filed as: MICHAEL F FAHEY LII | 411 AVENIDA ADOBE SAN CLEMENTE, CA 92672 | COLONIAL LIFE | $1K | $675 | $2K | 4.34% |
| BRIAN YERVANT AKIAN3 | 503 SPRINGBROOK NORTH IRVINE, CA 92614 | COLONIAL LIFE | $1K | $307 | $2K | 4.12% |
| MARGARITA ALEJANDRA RAMIREZ3 | 1356 CALLE COLNETT SAN MARCOS, CA 92069 | COLONIAL LIFE | $1K | $373 | $2K | 3.78% |
| GOLD RIVER FINANCIAL GROUP LLC3 | 2807 GRATTON ST RIVERSIDE, CA 92504 | COLONIAL LIFE | $657 | $170 | $827 | 1.90% |
| LILIANA RIVERA3 | 25671 TONADILLA CIR MORENO VALLEY, CA 92551 | COLONIAL LIFE | $479 | $79 | $558 | 1.28% |
| UZIEL RIVERA3 | 1267 SILVER TORCH DRIVE BEAUMONT, CA 92223 | COLONIAL LIFE | $287 | $124 | $411 | 0.95% |
| ROSE VILLALON PASQUEL3 | 552 E CARSON ST CARSON, CA 90745 | COLONIAL LIFE | $309 | $61 | $370 | 0.85% |
| MARIA YVONNE RODIGHIERO3 | 28502 SHRIKE DRIVE LAGUNA NIGUEL, CA 92677 | COLONIAL LIFE | $294 | $32 | $326 | 0.75% |
| JOHANA HERMILA MEDINA3 | 13265 RIVER OAKS DR RANCHO CUCAMONGA, CA 91739 | COLONIAL LIFE | $314 | — | $314 | 0.72% |
| CYNTHIA MARINA INGLE3 | 1834 KNAPP DR VISTA, CA 92084 | COLONIAL LIFE | $291 | $8 | $299 | 0.69% |
| NISSAH LIA AGUILAR3 Filed as: NISSAH LIA AGULIAR | 33556 MAPLEWOOD CT TEMECULA, CA 92592 | COLONIAL LIFE | $266 | — | $266 | 0.61% |
| CHRISTINA ROMAN3 | 434 W COLUMBIA AVE POMONA, CA 91768 | COLONIAL LIFE | $251 | $14 | $265 | 0.61% |
| SHERRI BARHAM3 | 24694 PASEO DE TORONTO YORBA LINDA, CA 92887 | COLONIAL LIFE | $144 | $2 | $146 | 0.34% |
| CONSUMER DRIVEN BENEFITS LLC3 | 3737 BIRCH ST NEWPORT BEACH, CA 92660 | COLONIAL LIFE | $45 | $74 | $119 | 0.27% |
| TIM CHRISTOPHER ELLIS3 | P.O. BOX 483 ORANGE, CA 92856 | COLONIAL LIFE | $98 | — | $98 | 0.23% |
| CLIENT BENEFIT INSURANCE SERVICES3 | 5675 RUFFIN ROAD SAN DIEGO, CA 92123 | COLONIAL LIFE | $73 | $11 | $84 | 0.19% |
| ERIC TERRAZAS3 | 217 LOIS ST LA HABRA, CA 90631 | COLONIAL LIFE | $64 | — | $64 | 0.15% |
| JENNIFER AURORA RAMIREZ3 | 1053 FICUS LANE SAN MARCOS, CA 92069 | COLONIAL LIFE | $62 | $2 | $64 | 0.15% |
| TINA HERNANDEZ3 | 11779 W COCOPAH ST AVONDALE, AZ 85323 | COLONIAL LIFE | $45 | $18 | $63 | 0.14% |
| JOHN D EVANGELISTA3 | 26111 ANTONIO PARKWAY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE | $43 | $15 | $58 | 0.13% |
| MARIA RUBY QUINTANA3 | 12141 CENTRALIA STREET LAKEWOOD, CA 90715 | COLONIAL LIFE | $23 | $32 | $55 | 0.13% |
| YOLO ENTERPRISE INC3 | 5460 E EL PRAQUE ST LONG BEACH, CA 90815 | COLONIAL LIFE | $24 | $17 | $41 | 0.09% |
| DAVID A. RACKLIFFE3 Filed as: DAVID A RACKLIFFE | 300 HEROIT CT SPRING HILL, TN 37174 | COLONIAL LIFE | $28 | $1 | $29 | 0.07% |
| INOCENCIA MAY CRAWFORD3 | 3055 FOOTHILL BLVD #3 LA CRESCENTA, CA 91214 | COLONIAL LIFE | $19 | $1 | $20 | 0.05% |
| WILLIAM DOUGLAS DEACON3 | 5391 VANGUARD AVE GARDEN GROVE, CA 92845 | COLONIAL LIFE | $12 | $1 | $13 | 0.03% |
| DEL DOWNEY3 | 41960 AVENIDA DE ANITA TEMECULA, CA 92592 | COLONIAL LIFE | $3 | $1 | $4 | 0.01% |
| MARIANNA REBECCA WEAVER3 | 20092 CHAMPLAIN LAKE FOREST, CA 92630 | COLONIAL LIFE | $1 | — | $1 | 0.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | DBA SHOREPOINT INSURANCE SERVICES COSTA MESA, CA 92626 | COLONIAL LIFE | $940 | $165 | $1K | 26.52% |
| DAVID O CHRISTENSEN3 | 180 MCKNIGHT DRIVE LAGUNA BEACH, CA 92651 | COLONIAL LIFE | $630 | $158 | $788 | 18.91% |
| MICHAEL F FAHEY III3 Filed as: MICHAEL F FAHEY LII | 411 AVENIDA ADOBE SAN CLEMENTE, CA 92672 | COLONIAL LIFE | $293 | $172 | $465 | 11.16% |
| JENNIFER AURORA RAMIREZ3 | 1053 FICUS LANE SAN MARCOS, CA 92069 | COLONIAL LIFE | $296 | $10 | $306 | 7.34% |
| MARIA YVONNE RODIGHIERO3 | 28502 SHRIKE DRIVE LAGUNA NIGUEL, CA 92677 | COLONIAL LIFE | $136 | $15 | $151 | 3.62% |
| LAMBERT MONTALBO3 | 26197 MIRADA ST HIGHLAND, CA 92346 | COLONIAL LIFE | $110 | $5 | $115 | 2.76% |
| NISSAH LIA AGUILAR3 | 33556 MAPLEWOOD CT TEMECULA, CA 92592 | COLONIAL LIFE | $82 | — | $82 | 1.97% |
| CONSUMER DRIVEN BENEFITS LLC3 | 3737 BIRCH ST NEWPORT BEACH, CA 92660 | COLONIAL LIFE | $10 | $17 | $27 | 0.65% |
| TINA HERNANDEZ3 | 11779 W COCOPAH ST AVONDALE, AZ 85323 | COLONIAL LIFE | $10 | $4 | $14 | 0.34% |
| GROUP SUPPLEMENTAL BENEFITS INC3 | 1003 EAST COOLEY DR COLTON, CA 92324 | COLONIAL LIFE | $8 | $2 | $10 | 0.24% |
| JON MALMBORG3 Filed as: JON CURTIS RICHERT | 183 SAWGRASS LANE CALIMESA, CA 92320 | COLONIAL LIFE | $8 | $2 | $10 | 0.24% |
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 | 191 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 191 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | CALIFORNIACHOICE | 98 | $730K |
| Dental | GUARDIAN | 191 | $104K |
| Vision | GUARDIAN | 191 | $104K |
| Life insurance | GUARDIAN | 191 | $104K |
| Other(3 contracts, 2 carriers) | GUARDIAN | 191 | $152K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 191 | — |
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.