| 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 | $38K | — | $38K | 5.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3 POLARIS WAY, 4TH FLOOR ALISO VIEJO, CA 92656 | GUARDIAN | $10K | $3K | $13K | 12.98% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | DBA SHOREPOINT INSURANCE SERVICES COSTA MESA, CA 92626 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6K | $95 | $7K | 11.12% |
| DAVID O CHRISTENSEN3 | 180 MCKNIGHT DRIVE LAGUNA BEACH, CA 92651 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $893 | $4K | 6.24% |
| JB CREATIVE SOLUTIONS LLC3 | 3881 FREEMAN WAY PROSPER, TX 75078 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $77 | $1K | 2.45% |
| MICHAEL F FAHEY III3 Filed as: MICHAEL F FAHEY | 103 PALM DRIVE SAN CLEMENTE, CA 92672 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $87 | $1K | 2.31% |
| RAYMOND KWOCKMAN GONG3 | 2180 FENTON PKWY SAN DIEGO, CA 92108 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $911 | $163 | $1K | 1.83% |
| LUZ CASTILLO BARRIGA3 | 22019 JUAN AVE HAWAIIAN GARDENS, CA 90716 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $952 | $27 | $979 | 1.67% |
| ERIC ALEXANDER NOVOA3 | 17871 SHADY VIEW DR CHINO HILLS, CA 91790 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $478 | $130 | $608 | 1.04% |
| MARIA YVONNE RODIGHIERO3 | 28502 SHRIKE DRIVE LAGUNA NIGUEL, CA 92677 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $458 | $54 | $512 | 0.87% |
| MARGARITA ALEJANDRA RAMIREZ3 | 1356 CALLE COLNETT SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $297 | $79 | $376 | 0.64% |
| LUIS RAFAEL VALLE3 | 2354 CHATKA LANE SAN BERNARDINO, CA 92410 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $307 | $12 | $319 | 0.55% |
| CHAU PHAN3 | 6 FOREST IRVINE, CA 92612 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $270 | — | $270 | 0.46% |
| JOHN D EVANGELISTA3 | 151 LAS FLORES ALISO VIEJO, CA 92656 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $173 | $79 | $252 | 0.43% |
| FRANCISCO JAVIER RUIZ3 | 10102 COURTNEY OAKS CIR APT 20 TAMPA, FL 33619 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $103 | $1 | $104 | 0.18% |
| JOHN ERLE HOFFMAN3 | 9556 CEDAR ST BELLFLOWER, CA 90706 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $83 | — | $83 | 0.14% |
| RUBEN RODRIGUEZ BAEZA3 | 10760 DROXFORD ST UNIT 3 CERRITOS, CA 90703 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $55 | $25 | $80 | 0.14% |
| LAMBERT MONTALBO3 | 26197 MIRADA ST HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $25 | $1 | $26 | 0.04% |
| NICHOLAS RYAN DERRICO3 | 1745 W ORANGEWOOD AVE STE 212 ORANGE, CA 92868 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $13 | $4 | $17 | 0.03% |
| DEBORAH RUSH KIMMONS3 | 37291 BOSLEY ST INDIO, CA 92203 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | $5 | $14 | 0.02% |
| ANTOINETTE MARI GARCIA3 | 905 EVENING CANYON ROAD BREA, CA 92821 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $11 | $1 | $12 | 0.02% |
| CORCORAN & HOYT LLC3 | 3905 TAMPA RD UNIT 2367 OLDSMAR, FL 34677 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | $4 | $12 | 0.02% |
| HIEDI S WEISHAUPT3 | 4520 29TH AVENUE CIR E PALMETTO, FL 34221 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $11 | — | $11 | 0.02% |
| UZIEL RIVERA3 | 1267 SILVER TORCH DRIVE BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | — | $7 | 0.01% |
| DEMOLYNEUX CORPORATION3 | 173A FLOWER STREET COSTA MESA, CA 92627 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | — | $6 | 0.01% |
| JASON JONES3 | 5 VIA DE LA MESA SAN BERNARDINO, CA 92410 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | — | $6 | 0.01% |
| CONSUMER DRIVEN BENEFITS LLC3 | 1301 DOVE ST NEWPORT BEACH, CA 92660 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | $4 | $6 | 0.01% |
| SUSIE A ESTRADA3 | 25742 PARK AVE SAN JUAN CAPISTRANO, CA 92675 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | $1 | $5 | 0.01% |
| LILIANA RIVERA3 | 25671 TONADILLA CIR MORENA VALLEY, CA 92551 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.01% |
| TINA HERNANDEZ3 | 11779 W COCOPAH ST AVONDALE, AZ 85323 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | $1 | $3 | 0.01% |
| MARIANNA REBECCA WEAVER3 | 20092 CHAMPLAIN LAKE FOREST, CA 92630 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| GOLD RIVER FINANCIAL GROUP LLC3 | 2807 GRATTON ST RIVERSIDE, CA 92504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 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 | 198 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 198 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIACHOICE | 119 | $770K |
| Dental | GUARDIAN | 191 | $103K |
| Vision | GUARDIAN | 191 | $103K |
| Life insurance | GUARDIAN | 191 | $103K |
| Other(2 contracts, 2 carriers) | GUARDIAN | 191 | $162K |
| 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.