| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FMLASOURCE INC3 Filed as: FMLASOURCE INC. | 455 NORTH CITYFRONT PLAZA DRIVE 13TH FLOOR CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $31K | $31K | 11.91% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $13K | $15K | $29K | 11.13% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE AND PRENTICE HOLDING COMPANY | PO BOX 62949 VIRGINIA BEACH, VA 23466 | CONTINENTAL AMERICAN INSURANCE COMPANY | $16K | $0 | $16K | 20.33% |
| MARJORIE B. YACOPETTI3 Filed as: MARJORIE YACOPETTI AND OTHER AGENTS | PO BOX 2152 LODI, CA 95242 | CONTINENTAL AMERICAN INSURANCE COMPANY | $7K | $0 | $7K | 9.07% |
| PAULINE M. SIMPSON3 Filed as: PAULINE SIMPSON | 3546 BEN LANE STOCKTON, CA 95206 | CONTINENTAL AMERICAN INSURANCE COMPANY | $5K | $0 | $5K | 6.53% |
| ROMAN THOMAS SORIA3 | 1718 SYLVAN WAY, SUITE 808 LODI, CA 95242 | CONTINENTAL AMERICAN INSURANCE COMPANY | $2K | $0 | $2K | 2.08% |
| GUSTAVO ARRIAGA II3 | 5237 NORTH RIVERSIDE DRIVE SUITE 207 FORT WORTH, TX 76137 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1K | $0 | $1K | 1.83% |
| PETER JAMES SARANTIS3 Filed as: PETER J. SARANTIS | 1100 CORPORATE WAY, SUITE 100 FREDERIC KSBIRG, VA 22401 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1K | $0 | $1K | 1.77% |
| PATRICIA ARRIAGAANA3 | 980 ARLINGTON CIRCLE WOODLAND, CA 95695 | CONTINENTAL AMERICAN INSURANCE COMPANY | $985 | $0 | $985 | 1.24% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE AND PRENTICE HOLDING COMPANY | 2800 WEST MARCH LANE, SUITE 100 STOCKTON, CA 95219 | AFLAC | $3K | $0 | $3K | 5.09% |
| MJ INSURANCE3 Filed as: PETER SARANTIS AND VARIOUS AGENTS | 5509 SNOWBRUSH DRIVE ROCKLIN, CA 95677 | AFLAC | $3K | $48 | $3K | 4.73% |
| PAULINE M. SIMPSON3 Filed as: PAULINE SIMPSON | 752 WEST ALAMEDA STREET MANTECA, CA 95336 | AFLAC | $1K | $45 | $1K | 1.77% |
| BETH A. GRIFFIN3 | 9102 E LATHROP ROAD MANTECA, CA 95336 | AFLAC | $851 | $23 | $874 | 1.34% |
| BERNAVE NUNEZ3 | 784 EAST SPRINGFIELD AVENUE REEDLEY, CA 93654 | AFLAC | $687 | $12 | $699 | 1.07% |
| GUSTAVO ARRIAGA II3 | 320 WEST CORK TREE DRIVE ORANGE, CA 92865 | AFLAC | $640 | $0 | $640 | 0.98% |
| NEAL E. DAILY3 | 1852 WEST 11TH STREET, SUITE 310 TRACY, CA 95376 | AFLAC | $362 | $24 | $386 | 0.59% |
| USI INSURANCE SERVICES LLC4 | 3247 WEST MARCH LANE, SUITE 210 STOCKTON, CA 95219 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $1K | $0 | $1K | 6.31% |
| MARK MCDONALD4 Filed as: MARK D. MCDONALD | 1365 SEACOAST DRIVE, SUITE M IMPERIAL BEACH, CA 91932 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $601 | $0 | $601 | 3.28% |
| MJ INSURANCE4 Filed as: KANDRA KING AND VARIOUS AGENTS | 3453 BLUE ASH LANE LAS VEGAS, NV 89122 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $158 | $0 | $158 | 0.86% |
| STEVE BAKER4 | 153 ESTHER DRIVE COCOA BEACH, FL 32931 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $125 | $0 | $125 | 0.68% |
| LISA L BASS4 Filed as: LISA L. BASS | 1969 LITTLE MOUNTAIN ROAD ALEXIS, NC 28006 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $108 | $0 | $108 | 0.59% |
| THE AGURS GROUP INC.4 Filed as: THE AGURS GROUP, INC. | 5721 FRENCH LACE COURT NORTH LAS VEGAS, NV 89081 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $102 | $0 | $102 | 0.56% |
| THE SAMSON GROUP4 | 18 GREENGATE COURT SANTA ROSA, CA 95409 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $83 | $0 | $83 | 0.45% |
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 | 1,112 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,114 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,598 | $257K |
| Short-term disability | AFLAC | 159 | $65K |
| Other(3 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,598 | $355K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,598 | — |
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.