| 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 | $37K | — | $37K | 3.36% |
| AMWINS3 Filed as: AMWINS CONNECT INS SVCS LLC | — | CALIFORNIACHOICE | $30K | — | $30K | 2.66% |
| ACRISURE LLC3 Filed as: ACRISURE SOUTHWEST PARTNERS | INSURANCE SERVICES LLC 611 ANTON BLVD STE 1400 COSTA MESA, CA 92626 | CALIFORNIACHOICE | $18K | — | $18K | 1.63% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3 POLARIS WAY, 4TH FLOOR ALISO VIEJO, CA 92656 | GUARDIAN | $16K | $5K | $21K | 15.50% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 4000 WESTERLY PLACE NEWPORT BEACH, CA 92660 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $11K | — | $11K | 9.97% |
| ENROLL TECH INC3 | 396 CYPRESS DR APT F LAGUNA BEACH, CA 92651 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $3K | $6K | 5.49% |
| MICHAEL F FAHEY III3 Filed as: MICHAEL F FAHEY | 103 PALM DRIVE SAN CLEMENTE, CA 92672 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $1K | $4K | 3.37% |
| RAYMOND KWOCKMAN GONG3 | 1907 COLUMBIA ST APT 501 SAN DIEGO, CA 92101 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $447 | $3K | 2.97% |
| DAVID O CHRISTENSEN3 | 396 CYPRESS DR APT F LAGUNA BEACH, CA 92651 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $1K | $3K | 2.22% |
| RUBEN RODRIGUEZ BAEZA3 | 10760 DROXFORD ST UNIT 3 CERRITOS, CA 90703 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $353 | $2K | 1.77% |
| LUZ CASTILLO BARRIGA3 | 22019 JUAN AVE HAWAIIAN GARDENS, CA 90716 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $173 | $2K | 1.63% |
| RONALD E KIRKLAND3 Filed as: RONALD JONES | 320 NANCY CT MOSCOW, ID 83843 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $296 | $1K | 1.25% |
| MARIA C GONZALEZ3 | 11677 SANDPIPER CT MORENO VALLEY, CA 92557 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $777 | $204 | $981 | 0.87% |
| ACRISURE LLC3 Filed as: ACRISURE SOUTHWEST PARTNERS INSURAN | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $902 | — | $902 | 0.80% |
| JB CREATIVE SOLUTIONS LLC3 | 3881 FREEMAN WAY PROSPER, TX 75078 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $850 | $6 | $856 | 0.76% |
| LUIS RAFAEL VALLE3 | 2354 CHATKA LANE SAN BERNARDINO, CA 92410 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $504 | $45 | $549 | 0.49% |
| THOMAS LEE NICHOLS3 | 3671 STONEBROOK DR NORMAN, OK 73072 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $59 | $276 | $335 | 0.30% |
| ERIC ALEXANDER NOVOA3 | 17871 SHADY VIEW DR UNIT 1503 CHINO HILLS, CA 91709 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $223 | $30 | $253 | 0.22% |
| BERT KERR3 Filed as: BERT L KERR | PO BOX 5075 BENTON CITY, WA 99320 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $87 | $124 | $211 | 0.19% |
| JONATHON LOUIS TUTWILER3 | 507 S GRANT ST KENNEWICK, WA 99336 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $87 | $77 | $164 | 0.15% |
| CRYSTAL LYNN JONES3 | 303 S 197TH AVE BUCKEYE, AZ 85326 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $59 | $69 | $128 | 0.11% |
| MARGARITA ALEJANDRA RAMIREZ3 | 1356 CALLE COLNETT SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $96 | — | $96 | 0.09% |
| MARIA YVONNE RODIGHIERO3 | 28502 SHRIKE DRIVE LAGUNA NIGUEL, CA 92677 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $51 | — | $51 | 0.05% |
| ALEXANDRA SIBULKIN3 | 33 MEADOWOOD ALISO VIEJO, CA 92656 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $29 | — | $29 | 0.03% |
| CHAN PHAN3 | 6 FOREST IRVINE, CA 92612 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $27 | — | $27 | 0.02% |
| LAMBERT MONTALBO3 | 26197 MIRADA ST HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $23 | — | $23 | 0.02% |
| NELLIE F. PRESTON3 Filed as: NELLIE FRANCESCA PRESTON | 1133 KWIS AVE HACIENDA HEIGHTS, CA 91745 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16 | — | $16 | 0.01% |
| LILIANA RIVERA3 | 1267 SILVER TORCH DR BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16 | — | $16 | 0.01% |
| HEIDI S WEISHAUPT3 | 4520 29TH AVENUE CIR E PALMETTO, FL 34221 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 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 | 130 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 130 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIACHOICE | 130 | $1.1M |
| Dental | GUARDIAN | 207 | $132K |
| Vision | GUARDIAN | 207 | $132K |
| Life insurance | GUARDIAN | 207 | $132K |
| Other(2 contracts, 2 carriers) | GUARDIAN | 207 | $245K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 207 | — |
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.