| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP INC. | 2 PARK PLAZA SUITE 440 IRVINE, CA 92614 | CALIFORNIA PHYSICIANS' SERVICE | — | $69K | $69K | 5.32% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INSURANCE AGENCY | 2 PARK PLAZA SUITE 440 IRVINE, CA 92614 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | — | $7K | 9.91% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INSURANCE AGENCY | 18201 VON KARMAN AVENUE SUITE 1020 IRVINE, CA 92612 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $3K | $3K | 4.47% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 2.09% |
| HAYS COMPANIES, INC.3 Filed as: HAYS GROUP INC. | 1350 BAYSHORE HIGHWAY SUITE 218 BURLINGAME, CA 94010 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $6K | — | $6K | 9.44% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE AGENCY | OF VIRGINIA INC. 8570 MAGELLAN PARKWAY, SUITE 1100 RICHMOND, VA 23227 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | — | $780 | $780 | 1.14% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $587 | — | $587 | 0.86% |
| JOY E GUNDERSON3 Filed as: JOY E. GUNDERSON | 4531 VALLECITO LANE YORBA LINDA, CA 92886 | AFLAC | $2K | $106 | $2K | 5.56% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP INC. | 2 PARK PLAZA SUITE 440 IRVINE, CA 92614 | AFLAC | $989 | — | $989 | 2.47% |
| G SCOTT COOKE3 Filed as: SCOTT G. COOKE | 2832 NE 17TH AVENUE WILTON MANORS, FL 33334 | AFLAC | $539 | — | $539 | 1.35% |
| PATRICIA ANN BOSCH3 | 1561 E. ORANGETHORPE AVENUE SUITE 200 FULLERTON, CA 92831 | AFLAC | $381 | $76 | $457 | 1.14% |
| JONATHAN ALI HAJIMOMEN3 | 1561 E. ORANGETHORPE AVENUE SUITE 200 FULLERTON, CA 92831 | AFLAC | $411 | $30 | $441 | 1.10% |
| LAURA CANO3 | 718 PARK LANE CORONA, CA 92879 | AFLAC | $182 | — | $182 | 0.45% |
| PAUL B KIRTON JR3 Filed as: PAUL B. KIRTON JR | 5520 WILSHIRE BLVD. APT. 727 LOS ANGELES, CA 90036 | AFLAC | $116 | — | $116 | 0.29% |
| CHRISTOPHER L. TANG3 | 15155 LEFFINGWELL ROAD WHITTIER, CA 90604 | AFLAC | $92 | — | $92 | 0.23% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. PASADENA, CA 91107 | AFLAC | $91 | — | $91 | 0.23% |
| ROXEANNE C. BICKHAM3 | 27254 MAIN STREET HIGHLAND, CA 92346 | AFLAC | $81 | — | $81 | 0.20% |
| BARRY MCPHERSON INC3 Filed as: BARRY MCPHERSON INC. | 2211 MICHELSON DRIVE SUITE 1150 IRVINE, CA 92612 | AFLAC | $53 | — | $53 | 0.13% |
| 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 | $48 | — | $48 | 0.12% |
| DAVID SMITH3 Filed as: DAVID MATTHEW SMITH | 2001 E. FINANCIAL WAY SUITE 102 GLENDORA, CA 91741 | AFLAC | $42 | — | $42 | 0.10% |
| STRATEGIC LIFE INSURANCE3 | SERVICES INC. 2400 MAIN STREET, SUITE 200 IRVINE, CA 92614 | AFLAC | $32 | — | $32 | 0.08% |
| JAN C. CARROLL3 | 2103 CALLE OLA VERDE SAN CLEMENTE, CA 92673 | AFLAC | $28 | — | $28 | 0.07% |
| SCOTT W BLACKSHEAR3 Filed as: SCOTT W. BLACKSHEAR | 181 OLETA WAY ST. AUGUSTINE, FL 32095 | AFLAC | $25 | — | $25 | 0.06% |
| RANA JANE DENNIS3 | 18902 LASSO STREET APPLE VALLEY, CA 92308 | AFLAC | $24 | — | $24 | 0.06% |
| SHARI BOYCE3 | 12230 WINDCHIME PLACE APT. E EASTVALE, CA 91752 | AFLAC | $21 | — | $21 | 0.05% |
| REBECCA ORTIZ3 | 13337 SOUTH STREET SUITE 656 CERRITOS, CA 90703 | AFLAC | $17 | — | $17 | 0.04% |
| NICHOLAS E VIGIL3 Filed as: NICHOLAS R D'ERRICO | 1745 W. ORANGEWOOD AVENUE SUITE 212 ORANGE, CA 92868 | AFLAC | $17 | — | $17 | 0.04% |
| DANIEL TYLER ADAMSON3 | 405 S. HIBISCUS WAY ANAHEIM, CA 92808 | AFLAC | $16 | — | $16 | 0.04% |
| OLIVIA A. COTE3 | P.O. BOX 401 LA HONDA, CA 94020 | AFLAC | $14 | — | $14 | 0.03% |
| DALE IRA DAVIS3 | 5892 CEDARCREEK LANE LEXINGTON, KY 40515 | AFLAC | $14 | — | $14 | 0.03% |
| OWEN JOHNSTON3 | 1231 W. 2ND STREET SANTA ANA, CA 92703 | AFLAC | $14 | — | $14 | 0.03% |
| DOUGLAS J SUCHECKI3 Filed as: DOUGLAS J. SUCHECKI | 1224 PEACOCK AVENUE SUITE 205 COLUMBUS, GA 31906 | AFLAC | $9 | — | $9 | 0.02% |
| AARON D MCGOVERN3 Filed as: AARON D. MCGOVERN | 1794 AVENIDA REGINA SAN MARCOS, CA 92069 | AFLAC | $8 | — | $8 | 0.02% |
| DAVID J REESOR3 Filed as: DAVID J. REESOR | 1615 WILSON AVENUE UPLAND, CA 91784 | AFLAC | $6 | — | $6 | 0.01% |
| RONALD I MARTINDALE3 Filed as: RONALD I. MARTINDALE | 128 RUNNING CREEK LANE UPLAND, CA 91784 | AFLAC | $5 | — | $5 | 0.01% |
| CHRIS BRANSON3 | P.O. BOX 930 MAKAWAO, HI 96768 | AFLAC | $5 | — | $5 | 0.01% |
| TERRANCE M LUCZAJ3 Filed as: TERRANCE M. LUCZAL | 29 CRESTVIEW DRIVE RANCHO SANTA MARGARITA, CA 92688 | AFLAC | $3 | — | $3 | 0.01% |
| ANDREW R GRETHEL3 Filed as: ANDREW R. GRETHEL | 11739 HICKORY RUN COURT LOVELAND, OH 45140 | AFLAC | $3 | — | $3 | 0.01% |
| TERRENCE M LUCZAJ3 Filed as: TERRENCE M. LUCZAJ | 435 HARRODS LANE CHARLESTON, SC 29412 | AFLAC | $2 | — | $2 | 0.00% |
| MANA INSURANCE SOLUTIONS INC3 Filed as: MANA INSURANCE SOLUTIONS INC. | P.O. BOX 930 MAKAWAO, HI 96768 | AFLAC | $2 | — | $2 | 0.00% |
| TOMMY C FLEESON3 Filed as: TOMMY C. FLEESON | 3395 MICHELSON DRIVE APT. 5155 IRVINE, CA 92612 | AFLAC | $2 | — | $2 | 0.00% |
| JEFFREY T JOHNSON3 Filed as: JEFFREY T. JOHNSON | 30766 MAINMAST DRIVE AGOURA HILLS, CA 91301 | AFLAC | $1 | — | $1 | 0.00% |
| JAMES J GRETHEL3 Filed as: JAMES J. GRETHEL | 865 CEDAR DRIVE LOVELAND, OH 45140 | AFLAC | $1 | — | $1 | 0.00% |
| KERSTIN J VANZANTEN3 Filed as: KERSTIN J. VANZANTEN | 40152 STOWE ROAD TEMECULA, CA 92591 | AFLAC | $1 | — | $1 | 0.00% |
| MARK J WOOD3 Filed as: MARK J. WOOD | 315 W. HACIENDA DRIVE CORONA, CA 92882 | AFLAC | $1 | — | $1 | 0.00% |
| SHANE M OWEN3 Filed as: SHANE CRAIG DAVISON | 3013 LARGE HOP LANE ANTIOCH, TN 37013 | AFLAC | $1 | — | $1 | 0.00% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INSURANCE AGENCY | 2 PARK PLAZA SUITE 440 IRVINE, CA 92614 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | — | $5K | 16.60% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 3.40% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INSURANCE AGENCY | 18201 VON KARMAN AVENUE SUITE 1020 IRVINE, CA 92612 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $887 | $887 | 2.70% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INSURANCE AGENCY | 18201 VON KARMAN AVENUE SUITE 1020 IRVINE, CA 92612 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $706 | $706 | 5.50% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INSURANCE AGENCY | 18201 VON KARMAN AVENUE SUITE 1020 IRVINE, CA 92612 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $697 | $697 | 5.57% |
| HAYS COMPANIES, INC.3 Filed as: HAYS OF CALIFORNIA INSURANCE | SERVICES 80 S. 8TH STREET, SUITE 700 MINNEAPOLIS, MN 55402 | EYEMED VISION CARE | $687 | — | $687 | 6.34% |
| HAYS COMPANIES, INC.3 Filed as: HAYS OF CALIFORNIA INSURANCE | SERVICES 880 APOLLO STREET, SUITE 300 EL SEGUNDO, CA 90245 | EYEMED VISION CARE | $489 | — | $489 | 4.51% |
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 | 163 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 163 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA PHYSICIANS' SERVICE | 211 | $1.3M |
| Dental | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 207 | $68K |
| Vision | EYEMED VISION CARE | 181 | $11K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 163 | $45K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 163 | $74K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 163 | $13K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 211 | $1.3M |
| Other(3 contracts, 2 carriers) | AFLAC | 163 | $85K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 211 | — |
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.