| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE SOUTHWEST PARTNERS INS SVC | RAYMOND MARKLEY GRAND RAPIDS, MI 49503 | CALIFORNIACHOICE | $49K | — | $49K | 5.00% |
| AMWINS3 Filed as: AMWINS CONNECT INS SVCS LLC | — | CALIFORNIACHOICE | $26K | — | $26K | 2.66% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3 POLARIS WAY, 4TH FLOOR ALISO VIEJO, CA 92656 | GUARDIAN | $13K | $3K | $16K | 12.45% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | DBA SHOREPOINT INSURANCE SERVICES COSTA MESA, CA 92626 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10K | $133 | $10K | 11.44% |
| DAVID O CHRISTENSEN3 | 180 MCKNIGHT DRIVE LAGUNA BEACH, CA 92651 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $2K | $6K | 6.44% |
| LUZ CASTILLO BARRIGA3 | 22019 JUAN AVE HAWAIIAN GARDENS, CA 90716 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $169 | $3K | 3.33% |
| MICHAEL F FAHEY III3 Filed as: MICHAEL F FAHEY | 103 PALM DRIVE SAN CLEMENTE, CA 92672 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $198 | $2K | 2.79% |
| JB CREATIVE SOLUTIONS LLC3 | 3881 FREEMAN WAY PROSPER, TX 75078 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $299 | $2K | 2.63% |
| ERIC ALEXANDER NOVOA3 | 17871 SHADY VIEW DR CHINO HILLS, CA 91790 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $895 | $238 | $1K | 1.31% |
| LUIS RAFAEL VALLE3 | 2354 CHATKA LANE SAN BERNARDINO, CA 92410 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $926 | $131 | $1K | 1.22% |
| RAYMOND KWOCKMAN GONG3 | 2180 FENTON PKWY SAN DIEGO, CA 92108 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $770 | $186 | $956 | 1.10% |
| RUBEN RODRIGUEZ BAEZA3 | 10760 DROXFORD ST UNIT 3 CERRITOS, CA 90703 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $303 | $9 | $312 | 0.36% |
| ALEXANDRA SIBULKIN3 | 33 MEADOWOOD ALISO VIEJO, CA 92656 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $173 | $17 | $190 | 0.22% |
| LAMBERT MONTALBO3 | 26197 MIRADA ST HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $159 | — | $159 | 0.18% |
| MARIA YVONNE RODIGHIERO3 | 28502 SHRIKE DRIVE LAGUNA NIGUEL, CA 92677 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $111 | $9 | $120 | 0.14% |
| MARGARITA ALEJANDRA RAMIREZ3 | 1356 CALLE COLNETT SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $117 | — | $117 | 0.13% |
| NELLIE F. PRESTON3 Filed as: NELLIE FRANCESCA PRESTON | 1133 KWIS AVE HACIENDA HEIGHTS, CA 91745 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $105 | — | $105 | 0.12% |
| CHAN PHAN3 | 6 FOREST IRVINE, CA 92612 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $58 | — | $58 | 0.07% |
| JOHN D EVANGELISTA3 | 151 LAS FLORES ALISO VIEJO, CA 92656 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $26 | $18 | $44 | 0.05% |
| HEIDI S WEISHAUPT3 | 4520 29TH AVENUE CIR E PALMETTO, FL 34221 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $19 | — | $19 | 0.02% |
| LILIANA RIVERA3 | 1267 SILVER TORCH DR BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $15 | — | $15 | 0.02% |
| FRANCISCO JAVIER RUIZ3 | 10102 COURTNEY OAKS CIR APT 20 TAMPA, FL 33619 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.01% |
| UZIEL RIVERA3 | 1267 SILVER TORCH DRIVE BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| SUSIE A ESTRADA3 Filed as: SUSIE ESTRADA | 25742 PARK AVE SAN JUAN CAPISTRANO, CA 92675 | 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 | 124 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 124 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIACHOICE | 124 | $972K |
| Dental | GUARDIAN | 223 | $131K |
| Vision | GUARDIAN | 223 | $131K |
| Life insurance | GUARDIAN | 223 | $131K |
| Other(2 contracts, 2 carriers) | GUARDIAN | 223 | $218K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 223 | — |
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.