| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYS COMPANIES, INC.3 | 80 SOUTH 8TH STREET SUITE 700 MINNEAPOLIS, MN 55402 | BLUE SHIELD OF CALIFORNIA | $0 | $67K | $67K | 5.26% |
| HAYS COMPANIES, INC.3 | 80 SOUTH 8TH STREET SUITE 700 MINNEAPOLIS, MN 55402 | UNITED OF OMAHA LIFE INSURANCE COMPANY (MUTUAL OF OMAHA) | $10K | $3K | $13K | 13.11% |
| HAYS COMPANIES, INC.3 | 80 SOUTH 8TH STREET SUITE 700 MINNEAPOLIS, MN 55402 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $7K | — | $7K | 9.84% |
| JOY E GUNDERSON3 Filed as: JOY GUNDERSON | 4531 VALLECITO LN YORBA LINDA, CA 92886 | AFLAC | $3K | $227 | $3K | 7.80% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES, INC | 80 SOUTH 8TH STREET SUITE 700 MINNEAPOLIS, MN 55402 | AFLAC | $1K | — | $1K | 3.91% |
| PATRICIA ANN BOSCH3 | 1561 E ORANGETHORPE AVE STE 200 FULLERTON, CA 92831 | AFLAC | $1K | $140 | $1K | 3.49% |
| JONATHAN ALI HAJIMOMEN3 | 1561 E ORANGETHORPE AVE STE 200 FULLERTON, CA 92831 | AFLAC | $636 | $61 | $697 | 1.85% |
| G SCOTT COOKE3 | 2832 NE 17TH AVE WILTON MANORS, FL 33334 | AFLAC | $468 | — | $468 | 1.24% |
| PAUL B KIRTON JR3 Filed as: PAUL B. KIRTON, JR. | 5520 WILSHIRE BLVD APT 727 LOS ANGELES, CA 90036 | AFLAC | $98 | — | $98 | 0.26% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON AND COMPANY | 3475 E FOOTHILL BLVD PASADENA, CA 91107 | AFLAC | $88 | — | $88 | 0.23% |
| OLIVIA A. COTE3 | P.O. BOX 401 LA HONDA, CA 94020 | AFLAC | $79 | — | $79 | 0.21% |
| CHRISTOPHER L. TANG3 | 15155 LEFFINGWELL ROAD WHITTIER, CA 90604 | AFLAC | $78 | — | $78 | 0.21% |
| BARRY MCPHERSON INC3 | 2211 MICHELSON DR STE 1150 IRVINE, CA 92612 | AFLAC | $45 | — | $45 | 0.12% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN AND BROWN OF CALIFORNIA INC | 500 N STATE COLLEGE BLVD. SUITE 400 ORANGE, CA 92868 | AFLAC | $42 | — | $42 | 0.11% |
| STRATEGIC LIFE INSURANCE3 Filed as: STRATEGIC LIFE INS SERVICES INC. | 1936 E DEERE AVE SANTA ANA, CA 92705 | AFLAC | $27 | — | $27 | 0.07% |
| JAN C. CARROLL3 | 2 PUERTO CARAVACA SAN CLEMENTE, CA 92672 | AFLAC | $24 | — | $24 | 0.06% |
| SCOTT W BLACKSHEAR3 Filed as: SCOTT W. BLACKSHEAR | 3453 CATHRYN DR COLUMBUS, GA 31906 | AFLAC | $21 | — | $21 | 0.06% |
| SHARI BOYCE3 | 1561 E ORANGETHORPE AVE STE 200 FULLERTON, CA 92831 | AFLAC | $15 | — | $15 | 0.04% |
| NICHOLAS E VIGIL3 Filed as: NICHOLAS R. D'ERRICO | 1745 W ORANGEWOOD AVE STE 212 ORANGE, CA 92868 | AFLAC | $14 | — | $14 | 0.04% |
| DANIEL TYLER ADAMSON3 | 405 S HIBISCUS WAY ANAHEIM, CA 92808 | AFLAC | $14 | — | $14 | 0.04% |
| ROXANNE C. BICKHAM3 | 27254 MAIN STREET HIGHLAND, CA 92346 | AFLAC | $12 | — | $12 | 0.03% |
| OWEN JOHNSTON3 | 796 N HART ST ORANGE, CA 92867 | AFLAC | $11 | — | $11 | 0.03% |
| REBECCA ORTIZ3 | PO BOX 59044 NORWALK, CA 90652 | AFLAC | $8 | — | $8 | 0.02% |
| DAVID SMITH3 Filed as: DAVID MATTHEW SMITH | 2220 E ROUTE 66 STE 215 GLENDORA, CA 91740 | AFLAC | $7 | — | $7 | 0.02% |
| DALE I DAVIS3 | 5892 CEDARCREEK LN LEXINGTON, KY 40515 | AFLAC | $6 | — | $6 | 0.02% |
| CHRIS BRANSON3 | P.O. BOX 930 MAKAWAO, HI 96768 | AFLAC | $6 | — | $6 | 0.02% |
| DALE I DAVIS3 Filed as: DALE I. DAVIS | 1856 TRAVELLER RD LEXINGTON, KY 40504 | AFLAC | $5 | — | $5 | 0.01% |
| REBECCA ORTIZ3 | 1315 CORONA POINTE CT CORONA, CA 92879 | AFLAC | $5 | — | $5 | 0.01% |
| RONALD I MARTINDALE3 Filed as: RONALD I. MARTINDALE | 2220 E ROUTE 66 STE 215 GLENDORA, CA 91740 | AFLAC | $4 | — | $4 | 0.01% |
| SHARI BOYCE3 | 12230 WINDCHIME PL APT E EASTVALE, CA 91752 | AFLAC | $3 | — | $3 | 0.01% |
| TERRANCE M LUCZAJ3 Filed as: TERRANCE M. LUCZAJ | 435 HARRODS LN CHARLESTON, SC 29412 | AFLAC | $2 | — | $2 | 0.01% |
| TERRANCE M LUCZAJ3 Filed as: TERRANCE M. LUCZAJ | 435 HARRODS LN CHARLESTON, CA 29412 | AFLAC | $2 | — | $2 | 0.01% |
| DAVID SMITH3 Filed as: DAVID MATTHEW SMITH | 3400 INLAND EMPIRE BLVD STE 101 ONTARIO, CA 91764 | AFLAC | $2 | — | $2 | 0.01% |
| TOMMY C FLEESON3 Filed as: TOMMY C. FLEESON | 1300 SHETTER AVE APT 1041 JACKSONVILLE BEACH, FL 32250 | AFLAC | $1 | — | $1 | 0.00% |
| MARK J WOOD3 Filed as: MARK J. WOOD | 315 W HACIENDA DR CORONA, CA 92882 | AFLAC | $1 | — | $1 | 0.00% |
| REBECCA ORTIZ3 | 1561 E ORANGETHORPE AVE STE 200 FULLERTON, CA 92831 | AFLAC | $1 | — | $1 | 0.00% |
| RONALD I MARTINDALE3 | 3400 INLAND EMPIRE BLVD STE 101 ONTARIO, CA 91764 | AFLAC | $1 | — | $1 | 0.00% |
| HAYS COMPANIES, INC.3 | 80 S. 8TH STREET SUITE 700 MINNEAPOLIS, MN 55402 | FIDELITY SECURITY LIFE INSURANCE COMPANY (EYEMED VISION CARE) | $1K | — | $1K | 9.14% |
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 | 161 | 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) | 162 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE SHIELD OF CALIFORNIA | 205 | $1.3M |
| Dental | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 222 | $70K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY (EYEMED VISION CARE) | 181 | $12K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY (MUTUAL OF OMAHA) | 161 | $98K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY (MUTUAL OF OMAHA) | 161 | $98K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY (MUTUAL OF OMAHA) | 161 | $98K |
| Prescription drug | BLUE SHIELD OF CALIFORNIA | 205 | $1.3M |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY (MUTUAL OF OMAHA) | 161 | $136K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 222 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.