| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RSC INSURANCE BROKERAGE INC3 Filed as: RSC INSURANCE BROKERAGE, INC. | 2101 FLORENCE AVENUE CINCINNATI, OH 45206 | BLUE CROSS OF CALIFORNIA | $15K | $0 | $15K | 2.61% |
| ACRISURE LLC3 Filed as: ACRISURE SW PARTNERS INS SVCS, LLC | 611 ANTON BOULEVARD, SUITE 1400 COSTA MESA, CA 92626 | BLUE CROSS OF CALIFORNIA | $14K | $0 | $14K | 2.42% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 100 OTTAWA AVENUE SW GRAND RAPIDS, MI 49503 | BLUE CROSS OF CALIFORNIA | $323 | $902 | $1K | 0.22% |
| JB CREATIVE SOLUTIONS LLC3 Filed as: JB CREATIVE SOLUTIONS, LLC | 3881 FREEMAN WAY PROSPER, TX 75078 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $71 | $1K | 16.66% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | UNKNOWN SAN DIEGO, CA 92108 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $783 | $0 | $783 | 8.81% |
| MICHAEL F FAHEY III3 Filed as: MICHAEL F. FAHEY LII | 103 PALM DRIVE SAN CLEMENTE, CA 92672 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $199 | $113 | $312 | 3.51% |
| ACRISURE LLC3 Filed as: ACRISURE SW PARTNERS INSURANCE | 100 OTTAWA AVENUE SW GRAND RAPIDS, MI 49503 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $132 | $0 | $132 | 1.48% |
| RSC INSURANCE BROKERAGE INC3 Filed as: RSC INSURANCE BROKERAGE, INC. | 160 FEDERAL STREET, 4TH FLOOR BOSTON, MA 02110 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $70 | $2 | $72 | 0.81% |
| ANTONIA MARIA HOLDEN & OTHERS3 | 8932 CREEKFORD DRIVE LAKESIDE, CA 92040 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $21 | $2 | $23 | 0.26% |
| ANDREA MARIE TIERCE3 | 1199 MADRONE LANE PLACERVILLE, CA 95667 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $21 | $0 | $21 | 0.24% |
| ACRISURE LLC3 Filed as: ACRISURE SW PARTNERS INS SVCS, LLC | 611 ANTON BOULEVARD, SUITE 1400 COSTA MESA, CA 92626 | ANTHEM LIFE INSURANCE COMPANY | $206 | $0 | $206 | 5.62% |
| RSC INSURANCE BROKERAGE INC3 Filed as: RSC INSURANCE BROKERAGE, INC. | PO BOX 736073 CHICAGO, IL 60673 | ANTHEM LIFE INSURANCE COMPANY | $187 | $0 | $187 | 5.11% |
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 | 155 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 158 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 93 | $560K |
| Dental | BLUE CROSS OF CALIFORNIA | 93 | $560K |
| Vision | BLUE CROSS OF CALIFORNIA | 93 | $560K |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 155 | $4K |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 93 | $560K |
| Other(2 contracts, 2 carriers) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 155 | $13K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 155 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.