| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 770 KENMOOR AVE SE SUITE 300 GRAND RAPIDS, MI 49546 | CALIFORNIACHOICE | $29K | — | $29K | 5.01% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 770 KENMOOR AVE SE SUITE 300 GRAND RAPIDS, MI 49546 | CALIFORNIACHOICE | $6K | — | $6K | 5.01% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 770 KENMOOR AVE SE GRAND RAPIDS, MI 49546 | GUARDIAN | $6K | $5K | $12K | 11.40% |
| ENROLLEASE3 | 660 YORK STREET SUITE 102 SAN FRANCISCO, CA 94110 | GUARDIAN | $3K | — | $3K | 2.57% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | DBA SHOREPOINT INSURANCE SERVICES COSTA MESA, CA 92626 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $230 | $4K | 10.69% |
| DAVID O CHRISTENSEN3 | 180 MCKNIGHT DRIVE LAGUNA BEACH, CA 92651 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $292 | $2K | 6.00% |
| MICHAEL F FAHEY III3 Filed as: MICHAEL F FAHEY | 9301 33RD ST NW DORAL, FL 33172 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $763 | $229 | $992 | 2.59% |
| BRIAN YERVANT AKIAN3 | PO BOX 17269 IRVINE, CA 92623 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $844 | $93 | $937 | 2.45% |
| JOHANA HERMILA MEDINA3 | 13265 RIVER OAKS DR RANCHO CUCAMONGA, CA 91739 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $808 | $25 | $833 | 2.18% |
| CARMEN SANDERS3 | 2109 ABRAZO DR WEST COVINA, CA 91791 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $356 | — | $356 | 0.93% |
| MARGARITA ALEJANDRA RAMIREZ3 | 1356 CALLE COLNETT SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $183 | $71 | $254 | 0.66% |
| WILLIAM DOUGLAS DEACON3 | 5391 VANGUARD AVE GARDEN GROVE, CA 92845 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $201 | — | $201 | 0.53% |
| KIMBERLY ANNE DEACON3 | 5391 VANGUARD AVE. GARDEN GROVE, CA 92845 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $154 | — | $154 | 0.40% |
| GOLD RIVER FINANCIAL GROUP LLC3 | 2807 GRATTON ST RIVERSIDE, CA 92504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $129 | $10 | $139 | 0.36% |
| LILIANA RIVERA3 | 25671 TONADILLA CIR MORENA VALLEY, CA 92551 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $98 | $5 | $103 | 0.27% |
| JENNIFER AURORA RAMIREZ3 | 1053 FICUS LANE SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $91 | $12 | $103 | 0.27% |
| UZIEL RIVERA3 | 1267 SILVER TORCH DRIVE BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $43 | $15 | $58 | 0.15% |
| ROSE VILLALON PASQUEL3 | 552 E CARSON ST CARSON, CA 90745 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $33 | $15 | $48 | 0.13% |
| MARIA YVONNE RODIGHIERO3 | 28502 SHRIKE DRIVE LAGUNA NIGUEL, CA 92677 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $39 | $3 | $42 | 0.11% |
| CRHISTINA ROMAN3 | 434 W COLUMBIA AVE POMONA, CA 91768 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $38 | — | $38 | 0.10% |
| CYNTHIA MARINA INGLE3 | 1834 KNAPP DR VISTA, CA 92084 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $33 | — | $33 | 0.09% |
| YOLO ENTERPRISE INC3 | 5460 E EL PRAQUE ST LONG BEACH, CA 90815 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $29 | $4 | $33 | 0.09% |
| MARIANNA REBECCA WEAVER3 | 20092 CHAMPLAIN LAKE FOREST, CA 92630 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $27 | — | $27 | 0.07% |
| NISSAH LIA AGUILAR3 | 33556 MAPLEWOOD CT TEMECULA, CA 92592 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $25 | — | $25 | 0.07% |
| TIM CHRISTOPHER ELLIS3 | PO BOX 483 ORANGE, CA 92856 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | — | $10 | 0.03% |
| DAVID A. RACKLIFFE3 Filed as: DAVID A RACKLIFFE | 300 HEROIT CT SPRING HILL, TN 37174 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | — | $10 | 0.03% |
| CLIENT BENEFIT INSURANCE SERVICES3 | 5675 RUFFIN ROAD SAN DIEGO, CA 92123 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | — | $10 | 0.03% |
| JOHN D EVANGELISTA3 | 26111 ANTONIO PARKWAY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | $4 | $9 | 0.02% |
| CONSUMER DRIVEN BENEFITS LLC3 | 3737 BIRCH ST NEWPORT BEACH, CA 92660 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | $3 | $7 | 0.02% |
| TINA HERNANDEZ3 | 11779 W COCOPAH ST AVONDALE, AZ 85323 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | $1 | $5 | 0.01% |
| MARIA RUBY QUINTANA3 | 112 N TOLAND AVE WEST COVINA, CA 91790 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | $2 | $4 | 0.01% |
| JOHANA HERMILA MEDINA3 | 13265 RIVER OAKS DR RANCHO CUCAMONGA, CA 91739 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $688 | $5K | 50.59% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | DBA SHOREPOINT INSURANCE SERVICES COSTA MESA, CA 92626 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $186 | $2K | 18.61% |
| DAVID O CHRISTENSEN3 | 180 MCKNIGHT DRIVE LAGUNA BEACH, CA 92651 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $999 | $171 | $1K | 12.95% |
| MARGARITA ALEJANDRA RAMIREZ3 | 1356 CALLE COLNETT SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $350 | $183 | $533 | 5.90% |
| MICHAEL F FAHEY III3 Filed as: MICHAEL F FAHEY | 9301 33RD ST NW DORAL, FL 33172 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $310 | $114 | $424 | 4.69% |
| CARMEN SANDERS3 | 2109 ABRAZO DR WEST COVINA, CA 91791 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $273 | — | $273 | 3.02% |
| JENNIFER AURORA RAMIREZ3 | 1053 FICUS LANE SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $120 | $14 | $134 | 1.48% |
| KIMBERLY ANNE DEACON3 | 5392 VANGUARD AVE. GARDEN GROVE, CA 92845 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $59 | — | $59 | 0.65% |
| LAMBERT MONTALBO3 | 26197 MIRADA ST HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $47 | $3 | $50 | 0.55% |
| MARIA YVONNE RODIGHIERO3 | 28502 SHRIKE DRIVE LAGUNA NIGUEL, CA 92677 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $41 | $6 | $47 | 0.52% |
| WILLIAM DOUGLAS DEACON3 | 5391 VANGUARD AVE GARDEN GROVE, CA 92845 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $29 | — | $29 | 0.32% |
| NISSAH LIA AGUILAR3 | 33556 MAPLEWOOD CT TEMECULA, CA 92592 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $26 | — | $26 | 0.29% |
| YOLO ENTERPRISE INC3 | 5460 E EL PRAQUE ST LONG BEACH, CA 90815 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | — | $7 | 0.08% |
| MARIANNA REBECCA WEAVER3 | 20092 CHAMPLAIN LAKE FOREST, CA 92630 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | — | $7 | 0.08% |
| CONSUMER DRIVEN BENEFITS LLC3 | 3737 BIRCH ST NEWPORT BEACH, CA 92660 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | $2 | $5 | 0.06% |
| GROUP SUPPLEMENTAL BENEFITS INC3 | 1003 EAST COOLEY DR. COLTON, CA 92324 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.03% |
| JON MALMBORG3 Filed as: JON CURTIS RICHERT | 35925 LEAH LN YUCAIPA, CA 92399 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.03% |
| TINA HERNANDEZ3 | 11779 W COCOPAH ST AVONDALE, AZ 85323 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 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 | 142 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 142 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | CALIFORNIACHOICE | 98 | $696K |
| Dental | GUARDIAN | 142 | $102K |
| Vision | GUARDIAN | 142 | $102K |
| Life insurance | GUARDIAN | 142 | $102K |
| Other(3 contracts, 2 carriers) | GUARDIAN | 142 | $149K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 142 | — |
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.