| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CUSTOM BENEFIT CONSULTANTS INC.3 | 300 SOUTH 4TH STREET SUITE 704 LAS VEGAS, NV 89101 | BLUE CROSS OF CALIFORNIA | $246K | $0 | $246K | 5.27% |
| CUSTOM BENEFIT CONSULTANTS INC.3 | 300 SOUTH 4TH STREET SUITE 704 LAS VEGAS, NV 89101 | KAISER FOUNDATION HEALTH PLAN OF HAWAII | $17K | $0 | $17K | 1.86% |
| CUSTOM BENEFIT CONSULTANTS INC.3 | 300 S 4TH STREET SUITE 704 LAS VEGAS, NV 891016023 | METROPOLITAN LIFE INSURANCE COMPANY | $33K | $0 | $33K | 12.32% |
| CUSTOM BENEFIT CONSULTANTS INC.3 Filed as: CUSTOM BENEFIT CONSULTANTS, INC. | 300 SOUTH 4TH STREET SUITE 704 LAS VEGAS, NV 89101 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $24K | $0 | $24K | 10.00% |
| CUSTOM BENEFIT CONSULTANTS INC.3 | 300 SOUTH 4TH STREET SUITE 704 LAS VEGAS, NV 89101 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $2K | $0 | $2K | 5.27% |
| BENEFIT COMMUNICATIONS INC3 Filed as: BENEFIT COMMUNICATIONS INC. | 2977 SIDCO DR. NASHVILLE, TN 37204 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $0 | $1K | 5.79% |
| FBP INSURANCE SERVICES3 Filed as: FBP INSURANCE SERVICES, LLC | 130 THEORY ST SUITE 200 IRVINE, CA 92612 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $216 | $0 | $216 | 0.94% |
| ROBERT WADE OLSON3 | 130 THEORY SUITE 200 IRVINE, CA 92612 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $54 | $0 | $54 | 0.24% |
| EMPLOYEE BENEFITS INTERNATIONAL3 | 4700 ROCKSIDE RD SUMMIT ONE SUITE 540 CLEVELAND, OH 44131 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $21 | $0 | $21 | 0.09% |
| GARY ALLAN PSOTKA3 | 23101 LAKE CENTER DRIVE SUITE 150 LAKE FOREST, CA 82630 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $14 | $0 | $14 | 0.06% |
| ROBERTO VELAZQUEZ3 Filed as: ROBERTO VELASQUEZ | 7 REATA RANCHO SANTA MARGARITA, CA 92688 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $14 | $0 | $14 | 0.06% |
| CUSTOM BENEFIT CONSULTANTS INC.3 Filed as: CUSTOM BENEFIT CONSULTANTS INC | 300 S 4TH STREET, SUITE 704 LAS VEGAS, NV 89101 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $0 | $1K | 8.42% |
| GARY A. PSOTKA3 | 23101 LAKE CENTER DRIVE SUITE 150 LAKE FOREST, CA 92630 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $652 | $0 | $652 | 5.29% |
| ROBERTO VELAZQUEZ3 Filed as: ROBERTO VELASQUEZ | 7 REATA RANCHO SANTA MARGARITA, CA 92688 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $652 | $0 | $652 | 5.29% |
| THUY N. PHAM3 Filed as: THUY N PHAM | 4000 MACARTHUR BLVD SUITE 550 NEWPORT BEACH, CA 92660 | AFLAC | $177 | $0 | $177 | 3.92% |
| GARY ALLAN PSOTKA3 | 23101 LAKE CENTER DR SUITE 150 LAKE FOREST, CA 92630 | AFLAC | $60 | $0 | $60 | 1.33% |
| NANCY J ATCHUE3 | 1785 NEWBERRY DR BULLHEAD CITY, AZ 86442 | AFLAC | $55 | $0 | $55 | 1.22% |
| MIRIAM HUNGERFORD3 | 33622 HOLTZ HILL RD DANA POINT, CA 92628 | AFLAC | $51 | $0 | $51 | 1.13% |
| RONALD B SALMON3 | 2203 AVENIDA OLIVA SAN CLEMENTE, CA 92673 | AFLAC | $49 | $0 | $49 | 1.08% |
| EUGENE PEREZ3 Filed as: EUGENE R PEREZ | 5 GRANDVIEW DR PALM COAST, FL 32137 | AFLAC | $31 | $0 | $31 | 0.69% |
| PEGGY K SALMON3 | 2203 AVENIDA OLIVA SAN CLEMENTE, CA 92673 | AFLAC | $24 | $0 | $24 | 0.53% |
| ANDREW R GRETHEL3 | 600 HIDDEN VALLEY RD #150 CARLSBAD, CA 92011 | AFLAC | $21 | $0 | $21 | 0.46% |
| BARRY MCPHERSON INC3 Filed as: BARRY MCPHERSON INC. | 2211 MICHELSON DR. SUITE 1150 IRVINE, CA 92612 | AFLAC | $3 | $0 | $3 | 0.07% |
| BENEFIT COMMUNICATIONS INC3 Filed as: BENEFIT COMMUNICATIONS INC. | 2977 SIDCO DRIVE NASHVILLE, TN 37204 | FIRST UNUM LIFE INSURANCE COMPANY | $38 | $0 | $38 | 4.50% |
| ROBERT WADE OLSON3 | 130 THEORY SUITE 200 IRVINE, CA 92612 | FIRST UNUM LIFE INSURANCE COMPANY | $9 | $0 | $9 | 1.07% |
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 | 709 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 713 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 827 | $5.6M |
| Dental(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 827 | $5.0M |
| Vision(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF HAWAII | 755 | $935K |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 836 | $277K |
| Short-term disability(3 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 836 | $289K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 836 | $265K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 827 | $5.6M |
| Other(6 contracts, 6 carriers) | KAISER FOUNDATION HEALTH PLAN OF HAWAII | 836 | $1.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 836 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.