| 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 | $42K | — | $42K | 4.99% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3 POLARIS WAY, 4TH FLOOR ALISO VIEJO, CA 92656 | GUARDIAN | $7K | $6K | $13K | 10.99% |
| ENROLLEASE3 | 660 YORK STREET SUITE 102 SAN FRANCISCO, CA 94110 | GUARDIAN | $411 | — | $411 | 0.35% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | DBA SHOREPOINT INSURANCE SERVICES COSTA MESA, CA 92626 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6K | $329 | $6K | 11.47% |
| DAVID O CHRISTENSEN3 | 180 MCKNIGHT DRIVE LAGUNA BEACH, CA 92651 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $2K | $5K | 8.46% |
| MARGARITA ALEJANDRA RAMIREZ3 | 1356 CALLE COLNETT SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $556 | $2K | 3.98% |
| JB CREATIVE SOLUTIONS LLC3 | 3881 FREEMAN WAY PROSPER, TX 75078 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $341 | $2K | 3.06% |
| MICHAEL F FAHEY III3 Filed as: MICHAEL F FAHEY | 103 PALM DRIVE SAN CLEMENTE, CA 92672 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $504 | $2K | 3.01% |
| LUZ CASTILLO BARRIGA3 | 22019 JUAN AVE HAWAIIAN GARDENS, CA 90716 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $846 | $94 | $940 | 1.73% |
| JOHN ERLE HOFFMAN3 | 9556 CEDAR ST BELLFLOWER, CA 90706 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $595 | $230 | $825 | 1.52% |
| LUIS RAFAEL VALLE3 | 2354 CHATKA LANE SAN BERNARDINO, CA 92410 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $630 | $123 | $753 | 1.38% |
| DEBORAH RUSH KIMMONS3 | 37291 BOSLEY ST INDIO, CA 92203 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $89 | $104 | $193 | 0.35% |
| RAYMOND KWOCKMAN GONG3 | 2180 FENTON PKWY SAN DIEGO, CA 92108 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $163 | $16 | $179 | 0.33% |
| ERIC ALEXANDER NOVOA3 | 17871 SHADY VIEW DR CHINO HILLS, CA 91790 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $150 | $28 | $178 | 0.33% |
| NICHOLAS RYAN DERRICO3 | 1745 W ORANGEWOOD AVE STE 212 ORANGE, CA 92868 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $67 | $72 | $139 | 0.26% |
| ANTOINETTE MARI GARCIA3 | 905 EVENING CANYON ROAD BREA, CA 92821 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $64 | $66 | $130 | 0.24% |
| DEMOLYNEUX CORPORATION3 | 173A FLOWER STREET COSTA MESA, CA 92627 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $45 | $67 | $112 | 0.21% |
| MARIA YVONNE RODIGHIERO3 | 28502 SHRIKE DRIVE LAGUNA NIGUEL, CA 92677 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $79 | $9 | $88 | 0.16% |
| JASON JONES3 | 5 VIA DE LA MESA SAN BERNARDINO, CA 92410 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $45 | $14 | $59 | 0.11% |
| GOLD RIVER FINANCIAL GROUP LLC3 | 2807 GRATTON ST RIVERSIDE, CA 92504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $28 | — | $28 | 0.05% |
| LILIANA RIVERA3 | 25671 TONADILLA CIR MORENA VALLEY, CA 92551 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $28 | — | $28 | 0.05% |
| JOHN D EVANGELISTA3 | 151 LAS FLORES ALISO VIEJO, CA 92656 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $17 | $8 | $25 | 0.05% |
| JOHANA HERMILA MEDINA3 | 13265 RIVER OAKS DR RANCHO CUCAMONGA, CA 91739 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $19 | — | $19 | 0.03% |
| CONSUMER DRIVEN BENEFITS LLC3 | 1301 DOVE ST NEWPORT BEACH, CA 92660 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | $9 | $19 | 0.03% |
| TINA HERNANDEZ3 | 11779 W COCOPAH ST AVONDALE, AZ 85323 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | $4 | $13 | 0.02% |
| UZIEL RIVERA3 | 1267 SILVER TORCH DRIVE BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | — | $8 | 0.01% |
| MARIANNA REBECCA WEAVER3 | 20092 CHAMPLAIN LAKE FOREST, CA 92630 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.01% |
| JENNIFER AURORA RAMIREZ3 | 1053 FICUS LANE SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | $1 | $2 | 0.00% |
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 | 116 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 116 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIACHOICE | 108 | $848K |
| Dental | GUARDIAN | 149 | $118K |
| Vision | GUARDIAN | 149 | $118K |
| Life insurance | GUARDIAN | 149 | $118K |
| Other(2 contracts, 2 carriers) | GUARDIAN | 149 | $173K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 149 | — |
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.