| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GRISWOLD & GRISWOLD INSURANCE3 Filed as: GRISWOLD & GRISWOLD INS AGENCY, INC | 2785 PACIFIC COAST HIGHWAY SUITE 308 TORRANCE, CA 90505 | CALIFORNIA PHYSICIANS' SERVICE | $25K | $0 | $25K | 3.24% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WORD & BROWN | 701 S PARKER ST, 8TH FL ORANGE, CA 92868 | CALIFORNIA PHYSICIANS' SERVICE | $0 | $18K | $18K | 2.25% |
| DANONE SIMPSON INSURANCE SERVICES3 Filed as: DANONE SIMPSON INSURANCE SVCS LLC | 5550 TOPANGA CANYON BLVD SUITE 310 WOODLAND HILLS, CA 91367 | CALIFORNIA PHYSICIANS' SERVICE | $14K | $0 | $14K | 1.76% |
| GRISWOLD & GRISWOLD INSURANCE3 Filed as: GRISWOLD & GRISWOLD INS AGENCY, INC | 2785 PACIFIC COAST HIGHWAY #308 TORRANCE, CA 90505 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $6K | $0 | $6K | 9.97% |
| MICHAEL SCOTT ROSEN3 | 2226 WHITE ST PASADENA, CA 91107 | AFLAC | $1K | $369 | $2K | 6.28% |
| DORA BOSTICK3 | 1620 S DITMAR ST OCEANSIDE, CA 92054 | AFLAC | $698 | $133 | $831 | 3.47% |
| SHEM J BOSTICK3 | 1620 S DITMAR ST OCEANSIDE, CA 92054 | AFLAC | $572 | $168 | $740 | 3.09% |
| ANDRES ORLANDO TRUJILLO3 | 205 S BROADWAY SUITE 208 LOS ANGELES, CA 90012 | AFLAC | $543 | $136 | $679 | 2.84% |
| DTLA BENEFITS3 | 1620 S DITMAR ST OCEANSIDE, CA 92054 | AFLAC | $465 | $0 | $465 | 1.94% |
| ASHLEY EILEEN VALDEZ3 | 14416 BRINK AVE NORWALK, CA 90650 | AFLAC | $297 | $87 | $384 | 1.61% |
| GREGORY BRITO3 | 255 S GRAND AVE APT 707 LOS ANGELES, CA 90012 | AFLAC | $174 | $59 | $233 | 0.97% |
| HERACLIO ORTIZ3 | 26015 CYPRESS ST APT 41 LOMITA, CA 90717 | AFLAC | $129 | $48 | $177 | 0.74% |
| JENNIFER DIAZ3 | 1122 W HERALD ST WEST COVINA, CA 91790 | AFLAC | $38 | $15 | $53 | 0.22% |
| ELIBERTO A FAJARDO3 | 111 S BARRANCA ST APT 241 WEST COVINA, CA 91791 | AFLAC | $16 | $7 | $23 | 0.10% |
| ELIBERTO A FAJARDO3 | 907 DEL RANCHO CT ONTARIO, CA 91762 | AFLAC | $1 | $0 | $1 | 0.00% |
| MICHAEL SCOTT ROSEN3 | 2226 WHITE STREET PASADENA, CA 91107 | MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY | $2K | $0 | $2K | 21.10% |
| DTLA BENEFITS3 | 1620 S DITMAR ST OCEANSIDE, CA 92054 | MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY | $734 | $0 | $734 | 9.50% |
| ANDRES ORLANDO TRUJILLO3 | 21338 MONETA AVE CARSON, CA 90745 | MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY | $136 | $0 | $136 | 1.76% |
| JODI STARK3 | 5500 KLUMP AVE, APT 516 N HOLLYWOOD, CA 916012538 | MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY | $136 | $0 | $136 | 1.76% |
| PEREGRINE CONSULTING LLC3 | 162 BODINE RD BERWYN, PA 19312 | MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY | $82 | $0 | $82 | 1.06% |
| DANONE SIMPSON INSURANCE SERVICES3 Filed as: DANONE SIMPSON | 5550 TOPANGA CANYON BLVD. SUITE 310 WOODLAND HILLS, CA 91367 | CALIFORNIA DENTAL NETWORK, INC. | $661 | $0 | $661 | 10.00% |
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 | 131 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 132 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA PHYSICIANS' SERVICE | 167 | $785K |
| Dental(2 contracts, 2 carriers) | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 123 | $67K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 123 | $61K |
| Life insurance | MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY | 14 | $8K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 167 | $785K |
| Other | AFLAC | 23 | $24K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 167 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.