| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 S. 8TH STREET SUITE 700 MINNEAPOLIS, MN 55402 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $51K | — | $51K | 4.34% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 S. 8TH STREET SUITE 700 MINNEAPOLIS, MN 55402 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $6K | $0 | $6K | 10.00% |
| JOY E GUNDERSON3 | 4531 VALLECITO LN YORBA LINDA, CA 92886 | AFLAC | $1K | $147 | $2K | 4.89% |
| G SCOTT COOKE3 | 2832 NE 17TH AVE WILTON MANORS, FL 33334 | AFLAC | $825 | $147 | $972 | 2.93% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP INC | 80 SOUTH 8TH STREET SUITE 700 MINNEAPOLIS, MN 55402 | AFLAC | $953 | $0 | $953 | 2.87% |
| OLIVIA COTE3 | 17417 SAN FERNANDO MISSION BLVD GRANADA HILLS, CA 91344 | AFLAC | $209 | $161 | $370 | 1.11% |
| PATRICIA ANN BOSCH3 Filed as: PATRICIA BOSCH | 1561 E ORANGETHORPE AVE STE 200 FULLERTON, CA 92831 | AFLAC | $363 | $0 | $363 | 1.09% |
| SHARI BOYCE3 | 1561 E ORANGETHORPE AVE STE 200 FULLERTON, CA 92831 | AFLAC | $267 | $0 | $267 | 0.80% |
| JONATHAN ALI HAJIMOMEN3 Filed as: JONATHAN HAJIMOMEN | 1561 E ORANGETHORPE AVE STE 200 FULLERTON, CA 92831 | AFLAC | $220 | $0 | $220 | 0.66% |
| JAN C. CARROLL3 Filed as: JAN CARROLL | 502 AVENIDA ACAPULCO SAN CLEMENTE, CA 92672 | AFLAC | $92 | $60 | $152 | 0.46% |
| CHRISTOPHER L. TANG3 Filed as: CHRISTOPHER TANG | 15155 LEFFINGWELL ROAD WHITTIER, CA 90604 | AFLAC | $144 | $0 | $144 | 0.43% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON AND COMPANY | 3475 E FOOTHILL BLVD PASADENA, CA 91107 | AFLAC | $135 | $0 | $135 | 0.41% |
| PAUL B KIRTON JR3 Filed as: PAUL KIRTON, JR. | 1932 E DEERE AVE STE 240 SANTA ANA, CA 92705 | AFLAC | $115 | $0 | $115 | 0.35% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN AND BROWN OF CALIFORNIA INC | 500 N STATE COLLEGE BLVD. STE 400 ORANGE, CA 92868 | AFLAC | $54 | $0 | $54 | 0.16% |
| BARRY MCPHERSON INC3 | 2211 MICHELSON DR STE 1150 IRVINE, CA 92612 | AFLAC | $53 | $0 | $53 | 0.16% |
| STRATEGIC LIFE INSURANCE3 Filed as: STRATEGIC LIFE INS SERVICES INC. | 1936 E DEERE AVE SANTA ANA, CA 92705 | AFLAC | $36 | $0 | $36 | 0.11% |
| G SCOTT COOKE3 Filed as: SCOTT BLACKSHEAR | 3453 CATHRYN DR COLUMBUS, GA 31906 | AFLAC | $32 | $0 | $32 | 0.10% |
| DANIEL TYLER ADAMSON3 Filed as: DANIEL ADAMSON | 2700 N MAIN ST STE 601 SANTA ANA, CA 92705 | AFLAC | $18 | $0 | $18 | 0.05% |
| REBECCA ORTIZ3 | 1561 E ORANGETHORPE AVE STE 200 FULLERTON, CA 92831 | AFLAC | $16 | $0 | $16 | 0.05% |
| NICHOLAS RYAN DERRICO3 Filed as: NICHOLAS D'ERRICO | 1745 W ORANGEWOOD AVE STE 212 ORANGE, CA 92868 | AFLAC | $16 | $0 | $16 | 0.05% |
| ROXANNE BICKHAM3 | 10350 BASELINE RD SPC 40 RANCHO CUCAMONGA, CA 91701 | AFLAC | $13 | $0 | $13 | 0.04% |
| DAVID SMITH3 | 1109 W 9TH ST UPLAND, CA 91786 | AFLAC | $10 | $0 | $10 | 0.03% |
| OWEN JOHNSTON3 | 796 N HART ST ORANGE, CA 92867 | AFLAC | $5 | $0 | $5 | 0.02% |
| DALE I DAVIS3 Filed as: DALE DAVIS | 350 E SHORT ST NUMBER 416 LEXINGTON, KY 40507 | AFLAC | $5 | $0 | $5 | 0.02% |
| RONALD I MARTINDALE3 Filed as: RONALD MARTINDALE | 1242 N SAN DIMAS CANYON RD SAN DIMAS, CA 91773 | AFLAC | $5 | $0 | $5 | 0.02% |
| TERRANCE M LUCZAJ3 Filed as: TERRANCE LUCZAJ | 255 E RINCON STREET SUITE 110 CORONA, CA 92879 | AFLAC | $4 | $0 | $4 | 0.01% |
| BANZAI INSURANCE SOLUTIONS INC3 | 344 THOMAS L BERKLEY WAY0 SUITE 238 OAKLAND, CA 94612 | AFLAC | $3 | $0 | $3 | 0.01% |
| AMANDA M GRIFFITH3 Filed as: AMANDA GRIFFITH | 11400 SE 8TH STREET #375 BELLEVUE, WA 98004 | AFLAC | $2 | $0 | $2 | 0.01% |
| KEVIN J MARKEL3 Filed as: KEVIN MARKEL | 1501 E ORANGETHORPE AVE STE 180 FULLERTON, CA 92831 | AFLAC | $1 | $0 | $1 | 0.00% |
| TOMMY C FLEESON3 Filed as: TOMMY FLEESON | 1300 SHETTER AVE APT 1041 JACKSONVILLE BEACH, FL 32250 | AFLAC | $0 | $0 | $0 | 0.00% |
| MARK WOOD3 | 315 W HACIENDA DR CORONA, CA 92882 | AFLAC | $0 | $0 | $0 | 0.00% |
| CHUCK CHAN3 | 4881 WINDSONG AVE LA PALMA, CA 90623 | AFLAC | $0 | $0 | $0 | 0.00% |
| SHANE DAVISON3 | 1300 SHETTER AVE APT 4202 JACKSONVILLE BEACH, FL 32250 | AFLAC | $0 | $0 | $0 | 0.00% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC | 80 S. 8TH STREET SUITE 700 MINNEAPOLIS, MN 55402 | FIDELITY SECURITY LIFE INSURANCE COMPANY (EYEMED VISION CARE) | $998 | — | $998 | 9.87% |
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 | 142 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 143 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 214 | $1.2M |
| Dental | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 214 | $1.2M |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY (EYEMED VISION CARE) | 174 | $10K |
| Life insurance | AMERICAN GENERAL LIFE INSURANCE COMPANY | 142 | $64K |
| Short-term disability | AMERICAN GENERAL LIFE INSURANCE COMPANY | 142 | $64K |
| Long-term disability | AMERICAN GENERAL LIFE INSURANCE COMPANY | 142 | $64K |
| Prescription drug | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 214 | $1.2M |
| Other(2 contracts, 2 carriers) | AMERICAN GENERAL LIFE INSURANCE COMPANY | 142 | $98K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 214 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.