| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | PO BOX 1788 GRAND RAPIDS, MI 49501 | UNITED HEALTHCARE INSURANCE COMPANY | $20K | $0 | $20K | 3.92% |
| C&B INSURANCE SERVICES INC3 | 1800 19TH ST BAKERSFIELD, CA 93301 | UNITED HEALTHCARE INSURANCE COMPANY | $5K | $0 | $5K | 1.08% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 1120 BRISTOL ST COSTA MESA, CA 92626 | KAISER FOUNDATION HEALTH PLAN | $11K | $0 | $11K | 3.85% |
| C&B INSURANCE SERVICES INC3 | 1800 19TH ST BAKERSFIELD, CA 93301 | KAISER FOUNDATION HEALTH PLAN | $3K | $0 | $3K | 1.13% |
| DAVID O CHRISTENSEN3 | 396 CYPRESS DR APT F LAGUNA BEACH, CA 92651 | COLONIAL LIFE & ACCIDENT COMPANY | $4K | $2K | $6K | 11.67% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA | DBA SHOREPOINT INS COSTA MESA, CA 92626 | COLONIAL LIFE & ACCIDENT COMPANY | $4K | $111 | $4K | 7.54% |
| ANDREA MARIE TIERCE3 | 1199 MADRONE LN PLACERVILLE, CA 95667 | COLONIAL LIFE & ACCIDENT COMPANY | $1K | $595 | $2K | 3.29% |
| LUIS ERNESTO PEREZ3 Filed as: LUIS PEREZ BENEFIT | 861 KENWOOD ST UPLAND, CA 91784 | COLONIAL LIFE & ACCIDENT COMPANY | $1K | $459 | $2K | 2.97% |
| LUIS RAFAEL VALLE3 | 2354 CHATKA LN SAN BERNADINO, CA 92410 | COLONIAL LIFE & ACCIDENT COMPANY | $1K | $102 | $1K | 2.40% |
| MICHAEL F FAHEY III3 Filed as: MICHAEL FAHEY | 103 PALM DR SAN CLEMENTE, CA 92672 | COLONIAL LIFE & ACCIDENT COMPANY | $798 | $27 | $825 | 1.50% |
| LORI ROBIN NISHIMORI3 | 9204 HOXIE CT BAKERSFIELD, CA 93311 | COLONIAL LIFE & ACCIDENT COMPANY | $546 | $33 | $579 | 1.05% |
| ELIZABETH CELIS3 | 2442 PALM PL HUNTINGTON PARK, CA 90255 | COLONIAL LIFE & ACCIDENT COMPANY | $536 | $0 | $536 | 0.97% |
| JOHN D EVANGELISTA3 | 186 LAS FLORES ALISO VIEJO, CA 92656 | COLONIAL LIFE & ACCIDENT COMPANY | $279 | $121 | $400 | 0.73% |
| RAYMOND KWOCKMAN GONG3 | 1907 COLUMBIA ST APT 501 SAN DIEGO, CA 92101 | COLONIAL LIFE & ACCIDENT COMPANY | $184 | $36 | $220 | 0.40% |
| ERIC ALEXANDER NOVOA3 | 17871 SHADY VIEW DR UNIT 1503 CHINO HILLS, CA 91709 | COLONIAL LIFE & ACCIDENT COMPANY | $146 | $22 | $168 | 0.31% |
| INSURICA, INC.3 Filed as: INSURICA CA INSURANCE SERVICES | DBA WALTER MORTENSEN BAKERSFIELD, CA 93311 | COLONIAL LIFE & ACCIDENT COMPANY | $129 | $0 | $129 | 0.23% |
| MARIA YVONNE RODIGHIERO3 | 28502 SHRIKE DR LAGUNA NIGUEL, CA 92677 | COLONIAL LIFE & ACCIDENT COMPANY | $100 | $5 | $105 | 0.19% |
| LUZ CASTILLO BARRIGA3 | 22019 JUAN AVE HAWAIIAN GARDENS, CA 90716 | COLONIAL LIFE & ACCIDENT COMPANY | $48 | $2 | $50 | 0.09% |
| C&B INSURANCE SERVICES INC3 | 1800 19TH STREET BAKERSFIELD, CA 93301 | COLONIAL LIFE & ACCIDENT COMPANY | $49 | $0 | $49 | 0.09% |
| BART EHINGER3 | 715 AVOCET WAY ARROYO GRANDE, CA 93420 | COLONIAL LIFE & ACCIDENT COMPANY | $29 | $0 | $29 | 0.05% |
| CONSUMER DRIVEN BENEFITS LLC3 | 1301 DOVE ST NEWPORT BEACH, CA 92660 | COLONIAL LIFE & ACCIDENT COMPANY | $9 | $19 | $28 | 0.05% |
| RUBEN RODRIGUEZ BAEZA3 | 10760 DROXFORD ST UNIT 3 CERRITOS, CA 90703 | COLONIAL LIFE & ACCIDENT COMPANY | $19 | $1 | $20 | 0.04% |
| TINA HERNANDEZ3 | 11779 W COCOPAH ST AVONDALE, AZ 85323 | COLONIAL LIFE & ACCIDENT COMPANY | $9 | $4 | $13 | 0.02% |
| CHRISTINE A MILLER3 Filed as: CHRISTINE MILLER | 703 RIVERWALK DR UNIT 102 MYRTLE BEACH, SC 29579 | COLONIAL LIFE & ACCIDENT COMPANY | $12 | $0 | $12 | 0.02% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3 POLARIS WAY 4TH FLOOR VIEJO, CA 92656 | GUARDIAN | $4K | $1K | $5K | 13.38% |
| C&B INSURANCE SERVICES INC3 | 1800 19TH STREET BAKERSFIELD, CA 93301 | GUARDIAN | $1K | $0 | $1K | 2.90% |
| ENROLL EASE3 | 660 YORK STREET SUITE 102 SAN FRANCISCO, CA 94110 | GUARDIAN | $964 | $0 | $964 | 2.54% |
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 | 125 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 125 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNITED HEALTHCARE INSURANCE COMPANY | 57 | $782K |
| Dental | GUARDIAN | 125 | $38K |
| Vision | GUARDIAN | 125 | $38K |
| Life insurance | GUARDIAN | 125 | $38K |
| Long-term disability | GUARDIAN | 125 | $38K |
| Other(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT COMPANY | 125 | $93K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 125 | — |
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.