| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYS COMPANIES, INC.3 Filed as: HAYS OF CALIFORNIA INSURANCE SVCS. | 18201 VON KARMAN AVENUE, SUITE 1020 IRVINE, CA 92612 | CALIFORNIA PHYSICIANS SERVICE | $46K | — | $46K | 3.00% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | CALIFORNIA PHYSICIANS SERVICE | $4K | — | $4K | 0.28% |
| HAYS COMPANIES, INC.3 Filed as: HAYS OF CALIFORNIA INSURANCE SVCS. | 80 SOUTH STREET, SUITE 700 MINNEAPOLIS, MN 55402 | DENTAL HEALTH SERVICES | $9K | — | $9K | 7.30% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | DENTAL HEALTH SERVICES | $2K | — | $2K | 1.46% |
| MJ INSURANCE3 Filed as: JOHN C. WILLY AND VARIOUS AGENTS | 4850 SAN JOSE STREET APARTMENT 160 MONTCLAIR, CA 91763 | AFLAC | $6K | $111 | $6K | 6.69% |
| HAYS COMPANIES, INC.3 Filed as: HAYS OF CALIFORNIA INSURANCE SVCS. | 18201 VON KARMAN AVENUE, SUITE 106 IRVINE, CA 92612 | AFLAC | $5K | — | $5K | 5.28% |
| KATHLEEN LEININGER INS SERVICES INC3 Filed as: KATHLEEN LEININGER INSURANCE SVCS. | 8880 BENSON AVENUE, SUITE 106 MONTCLAIR, CA 91763 | AFLAC | $3K | $30 | $3K | 3.65% |
| DOUGLAS J SUCHECKI3 Filed as: DOUGLAS J. SUCHECKI | 3850 VINE STREET, SUITE 130 RIVERSIDE, CA 92507 | AFLAC | $2K | $96 | $2K | 2.22% |
| DIANA HOMA3 | 8880 BENSON AVENUE, SUITE 106 MONTCLAIR, CA 91763 | AFLAC | $2K | $232 | $2K | 2.00% |
| TIFFANY ANNE KING3 | 9034 EAST EASTER PLACE, SUITE 202 CENTENNIAL, CO 80112 | AFLAC | $1K | $435 | $2K | 1.97% |
| CYNTHIA JAYNE GOODNICK3 | 8880 BENSON AVENUE, SUITE 106 MONTCLAIR, CA 91763 | AFLAC | $2K | — | $2K | 1.85% |
| HAYS COMPANIES, INC.3 Filed as: HAYS OF CALIFORNIA INSURANCE SVCS. | 18201 VON KARMAN AVENUE, SUITE 510 IRVINE, CA 92612 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | $1K | $9K | 10.76% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $752 | — | $752 | 0.89% |
| HAYS COMPANIES, INC.3 Filed as: HAYS OF CALIFORNIA INSURANCE SVCS. | 80 SOUTH STREET, SUITE 700 MINNEAPOLIS, MN 55402 | EYEMED | $4K | — | $4K | 12.74% |
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 | 319 | 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) | 322 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 344 | $1.6M |
| Dental | DENTAL HEALTH SERVICES | 551 | $121K |
| Vision | EYEMED | 432 | $31K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 250 | $85K |
| Short-term disability(2 contracts, 2 carriers) | AFLAC | 250 | $177K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 250 | $85K |
| Prescription drug | CALIFORNIA PHYSICIANS SERVICE | 344 | $1.5M |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 300 | $92K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 551 | — |
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.