| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3 POLARIS WAY 4TH FLOOR ALISO VIEJO, CA 92656 | GUARDIAN | $8K | $884 | $9K | 12.17% |
| ENROLL TECH INC3 | 396 CYPRESS DR APT F LAGUNA BEACH, CA 92651 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7K | $6K | $13K | 25.36% |
| JAMEL WRIGHT3 | 4 BUDD ST LEDGEWOOD, NJ 07852 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5K | $168 | $5K | 10.33% |
| MICHAEL F FAHEY III3 | 103 PALM DR SAN CLEMENTE, CA 92672 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $2K | $5K | 8.83% |
| RUBEN RODRIGUEZ BAEZA3 | 10760 DROXFORD ST UNIT 3 CERRITOS, CA 90703 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $647 | $4K | 7.35% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 4000 WESTERLY PLACE NEWPORT BEACH, CA 92660 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | — | $3K | 6.68% |
| BROWN & BROWN INSURANCE SERVICES3 Filed as: JAMAL MICHAEL BROWN | 12024 MAGAZINE ST APT 9208 ORLANDO, FL 32828 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $532 | $2K | $2K | 4.01% |
| ACRISURE LLC3 Filed as: ACRISURE SW PARTNER INS | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 2.27% |
| NATIONAL ENROLLMENT PARTNERS LLC3 | CO NATIONAL ENROLLMENT PARTNERS CRANSTON, RI 02920 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $245 | $280 | $525 | 1.02% |
| LUCAS GARTENMAYER3 | 39051 12TH AVE ZEPHYRHILLS, FL 33542 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $434 | $65 | $499 | 0.97% |
| RAYMOND KWOCKMAN GONG3 | 1907 COLUMBIA ST APT 501 SAN DIEGO, CA 92101 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $382 | $61 | $443 | 0.86% |
| LAURA ROMEIRO3 | 10611 LURE PL PARRISH, FL 34219 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $345 | — | $345 | 0.67% |
| WORKSITE AMERICA LLC3 | 14141 46TH ST N STE 1209 CLEARWATER, FL 33762 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $59 | $40 | $99 | 0.19% |
| CHOICE BENEFITS SOLUTIONS LLC3 | 11399 81ST PL SEMINOLE, FL 33772 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $33 | $58 | $91 | 0.18% |
| SHIRLEY B DRAKE3 | 14141 46TH ST N STE 1209 CLEARWATER, FL 33762 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $26 | — | $26 | 0.05% |
| HEIDI S WEISHAUPT3 | 4520 29TH AVENUE CIR E PALMETTO, FL 34221 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $23 | — | $23 | 0.04% |
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 | 215 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 215 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | GUARDIAN | 193 | $74K |
| Vision | GUARDIAN | 193 | $74K |
| Life insurance | GUARDIAN | 193 | $74K |
| Other(2 contracts, 2 carriers) | GUARDIAN | 193 | $126K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 193 | — |
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.