| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INSURANCE | SERVICES LLC 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | AETNA HEALTH, INC. | $42K | $4K | $45K | 4.41% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | AETNA HEALTH, INC. | $9K | — | $9K | 0.89% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INSURANCE | SERVICES LLC 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | AETNA LIFE INSURANCE CO. | $22K | $14K | $36K | 6.65% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | AETNA LIFE INSURANCE CO. | $5K | — | $5K | 0.84% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS5 | P.O. BOX 9201 AUSTIN, TX 787669201 | METROPOLITAN LIFE INSURANCE COMPANY | $39K | $9K | $48K | 24.06% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS INC. | 422 WAUPONSEE STREET MORRIS, IL 604502215 | METROPOLITAN LIFE INSURANCE COMPANY | — | $3K | $3K | 1.53% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INSURANCE | SERVICES LLC P.O. BOX 19763 IRVINE, CA 926239763 | METROPOLITAN LIFE INSURANCE COMPANY | — | $2K | $2K | 1.01% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | METROPOLITAN LIFE INSURANCE COMPANY | — | $997 | $997 | 0.50% |
| EDWARD ANDERSON JR3 | 10003 RIDER COURT HAGERSTOWN, MD 21740 | AFLAC | $5K | $502 | $6K | 11.54% |
| JACOB BURNS INC.3 Filed as: JACOB BURNS, INC. | 11637 GORHAM AVENUE APT. 106 LOS ANGELES, CA 90049 | AFLAC | $5K | $335 | $5K | 10.37% |
| KATRINA LAFATA3 | 11637 GORHAM AVENUE APT. 106 LOS ANGELES, CA 90049 | AFLAC | $746 | — | $746 | 1.55% |
| BRYAN FISH3 | 4050 CANDLE LIGHT DRIVE DAYTON, MD 21036 | AFLAC | $636 | $84 | $720 | 1.49% |
| HEINZ SCHULMEISTER3 | 2663 CENTINELA AVENUE UNIT 202 SANTA MONICA, CA 90405 | AFLAC | $710 | — | $710 | 1.47% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INSURANCE | SERVICES LLC 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | AFLAC | $640 | — | $640 | 1.33% |
| BRYSTRA INSURANCE SERVICES3 Filed as: BRYSTRA INSURANCE SERVICES INC. | 11150 W. OLYMPIC BLVD. SUITE 780 LOS ANGELES, CA 90064 | AFLAC | $339 | — | $339 | 0.70% |
| MARY B PAULSON3 Filed as: MARY PAULSON | 427 S. QUAY PLACE KENNEWICK, WA 99336 | AFLAC | $278 | $32 | $310 | 0.64% |
| TERESA PHILLIPS3 | 1742 W. LINCOLN AVENUE APT. L1 ANAHEIM, CA 92801 | AFLAC | $286 | — | $286 | 0.59% |
| LISA COLVILLE3 | 2031 CRAWFORD DRIVE WALLA WALLA, WA 99362 | AFLAC | $188 | $23 | $211 | 0.44% |
| MONA MARCOS3 | 6765 CACTUS LANE LA VERNE, CA 91750 | AFLAC | $207 | — | $207 | 0.43% |
| GEOFFREY MALAIS3 | 16800 DEVONSHIRE STREET SUITE 220 GRANADA HILLS, CA 91344 | AFLAC | $181 | — | $181 | 0.38% |
| STEVEN R. JOHNSON3 Filed as: STEVEN JOHNSON | 6167 BRISTOL PARKWAY SUITE 106 CULVER CITY, CA 90230 | AFLAC | $157 | — | $157 | 0.33% |
| JANELLE M ZAMORA3 Filed as: JANELLE ZAMORA | 421 W. BROADWAY APT. 4157 LONG BEACH, CA 90802 | AFLAC | $132 | — | $132 | 0.27% |
| DAVID HERNANDEZ3 | 1160 E. MARIPOSA AVENUE EL SEGUNDO, CA 90245 | AFLAC | $113 | — | $113 | 0.23% |
| JOSEPH A BUZZELLO3 Filed as: JOSEPH BUZZELLO | 9018 BALBOA BLVD. SUITE 254 NORTHRIDGE, CA 91325 | AFLAC | $103 | — | $103 | 0.21% |
| GROSSLIGHT INSURANCE INC.3 | 1333 WESTWOOD BLVD. LOS ANGELES, CA 90024 | AFLAC | $90 | — | $90 | 0.19% |
| JOSEPH L. AGAGON3 Filed as: JOSEPH AGAGON | 421 W. BROADWAY LONG BEACH, CA 90802 | AFLAC | $77 | — | $77 | 0.16% |
| MICHAEL A MAYER3 Filed as: MICHAEL MAYER | P.O. BOX 5625 PASCO, WA 99302 | AFLAC | $55 | $9 | $64 | 0.13% |
| ADAM H MICHAELS3 Filed as: ADAM MICHAELS | 2922 CORDA LANE LOS ANGELES, CA 90049 | AFLAC | $38 | — | $38 | 0.08% |
| CLAY W CAMPBELL3 Filed as: CLAY CAMPBELL | 14720 LIBLEN AVENUE BELLFLOWER, CA 90706 | AFLAC | $38 | — | $38 | 0.08% |
| EDWIN VALASQUEZ3 | 1216 MERRY LANE WEST COVINA, CA 91792 | AFLAC | $36 | — | $36 | 0.07% |
| TOMMY L JOHNSON JR3 Filed as: TOMMY JOHNSON JR. | 711 S. OLIVE STREET APT. 314 LOS ANGELES, CA 90014 | AFLAC | $9 | — | $9 | 0.02% |
| GARY SCOTT NELLIS3 Filed as: GARY NELLIS | 10607 1/2 WOODBRIDGE STREET TOLUCA LAKE, CA 91602 | AFLAC | $8 | — | $8 | 0.02% |
| CHRISTOPHER HAGER3 | 8021 TRUXTON AVENUE LOS ANGELES, CA 90045 | AFLAC | $6 | — | $6 | 0.01% |
| MICHAEL C WALKER3 Filed as: MICHAEL STACHOWIAK | 321 N. CLARK STREET SUITE 625 CHICAGO, IL 60654 | AFLAC | $6 | — | $6 | 0.01% |
| WILLIS TOWERS WATSON US LLC3 Filed as: JOSEPH WILLIS JR. | 1431 NE 55TH STREET FORT LAUDERDALE, FL 33334 | AFLAC | $6 | — | $6 | 0.01% |
| JOSEPH P CALARCO3 Filed as: JOSEPH NASCA | 28081 W. MAPLE AVENUE BARRINGTON, IL 60010 | AFLAC | $6 | — | $6 | 0.01% |
| SHELIA H. HARTMAN3 Filed as: SHELIA HARTMAN | 22801 VENTURE BLVD. SUITE 205 WOODLAND HILLS, CA 91364 | AFLAC | $5 | — | $5 | 0.01% |
| LARA K GRANDE3 Filed as: LARA GRANDE | 117 MORNING MIST LANE FRANKLIN, TN 37064 | AFLAC | $4 | — | $4 | 0.01% |
| ALLISON FARRIS WENDELBERGER3 | 207 SANTA FE DRIVE WALNUT CREEK, CA 94598 | AFLAC | $1 | — | $1 | 0.00% |
| MEGHAN MILLER3 | 6631 FOX RIDGE CIRCLE DAVIDSON, NC 28036 | AFLAC | $1 | — | $1 | 0.00% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS INC. | 422 WAUPONSEE STREET MORRIS, IL 604502215 | SAFEGUARD HEALTH PLANS, INC. | — | $464 | $464 | 1.43% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INSURANCE | SERVICES LLC P.O. BOX 19763 IRVINE, CA 926239763 | SAFEGUARD HEALTH PLANS, INC. | — | $329 | $329 | 1.01% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | SAFEGUARD HEALTH PLANS, INC. | — | $163 | $163 | 0.50% |
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 | 255 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 255 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | AETNA HEALTH, INC. | 298 | $1.6M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 465 | $234K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 465 | $201K |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 465 | $249K |
| Short-term disability | AFLAC | 38 | $48K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 465 | $201K |
| Prescription drug(2 contracts, 2 carriers) | AETNA HEALTH, INC. | 298 | $1.6M |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 465 | $249K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 465 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.