| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 100 OTTAWA AVENUE SW GRAND RAPIDS, MI 49503 | AETNA HEALTH, INC. | $88K | $0 | $88K | 3.60% |
| PENBEN FINANCIAL SERVICES INC. DBA3 Filed as: PENBEN FINANCIAL SERVICES, INC. DBA | 3744 MT. DIABLO BLVD LAFAYETTE, CA 94549 | AETNA HEALTH, INC. | $35K | $0 | $35K | 1.43% |
| PENBEN FINANCIAL SERVICES INC. DBA3 Filed as: PENBEN FINANCIAL SERVICES, INC. DBA | 3744 MT. DIABLO BLVD LAFAYETTE, CA 94549 | AETNA HEALTH, INC. | $0 | $20K | $20K | 0.82% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA | 23716 BIRTCHER DR. LAKE FOREST, CA 92630 | GUARDIAN | $65K | $11K | $76K | 14.26% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 100 OTTAWA AVENUE SW GRAND RAPIDS, MI 49503 | AETNA HEALTH, INC. | $9K | $0 | $9K | 3.75% |
| PENBEN FINANCIAL SERVICES INC. DBA3 Filed as: PENBEN FINANCIAL SERVICES, INC. DBA | 3744 MT. DIABLO BLVD LAFAYETTE, CA 94549 | AETNA HEALTH, INC. | $0 | $8K | $8K | 3.67% |
| PENBEN FINANCIAL SERVICES INC. DBA3 Filed as: PENBEN FINANCIAL SERVICES, INC. DBA | 3744 MT. DIABLO BLVD LAFAYETTE, CA 94549 | AETNA HEALTH, INC. | $3K | $0 | $3K | 1.33% |
| BRYSON INSURANCE AGENCY INC.3 Filed as: BRYSON INSURANCE AGENCY INC | 3777 LONG BEACH BLVD STE 500 LONG BEACH, CA 90807 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $92 | $0 | $92 | 1.24% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC DBA BXA | 100 OTTAWA AVENUE GRAND RAPIDS, MI 49503 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $85 | $0 | $85 | 1.15% |
| JOHN D EVANGELISTA3 | 186 LAS FLORES ALISO VIEJO, CA 92656 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $80 | $0 | $80 | 1.08% |
| TIM CHRISTOPHER ELLIS3 | PO BOX 483 ORANGE, CA 92856 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $70 | $0 | $70 | 0.95% |
| GCG FINANCIAL LLC3 Filed as: TAMI SUE DICKERSON | 1719 S PINTO DR APACHE JUNCTION, AZ 85120 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $47 | $0 | $47 | 0.64% |
| BENEFITS EXCHANGE ALLIANCE3 Filed as: BENEFITS EXCHANGE ALLIANCE INC | 23716 BIRTCHER DR LAKE FOREST, CA 92630 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $44 | $0 | $44 | 0.60% |
| BENEFITS AMERICA INSURANCE SERVICES3 | 6320 CANOGA AVENUE WOODLAND HILLS, CA 91367 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $38 | $0 | $38 | 0.51% |
| MARIA C GONZALEZ3 | 11677 SANDPIPER CT MORENO VALLEY, CA 92557 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | $0 | $4 | 0.05% |
| MIKE MCCORMICK3 | 7 MONSERRAT PL FOOTHILL RANCH, CA 92610 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | $0 | $4 | 0.05% |
| ASCENSION BENEFITS ADVISORS3 | 6 POMEGRANATE ST LADERA RANCH, CA 92694 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | $0 | $3 | 0.04% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GEORGE HORNE | 3410 MAGNOLIA WAY BROADVIEW HEIGHTS, OH 44147 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | $0 | $3 | 0.04% |
| MICHAEL C WALKER3 Filed as: MICHAEL J MINNEY | PO BOX 365 POWAY, CA 92074 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | $0 | $2 | 0.03% |
| STACI MARIE FERRARIS3 | 28912 GLENROCK PL HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | $0 | $2 | 0.03% |
| JIM BARRETT3 | 8514 E KRAIL ST SCOTTSDALE, AZ 85250 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | $0 | $1 | 0.01% |
| LILIANA RIVERA3 | 1267 SILVER TORCH DR BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | $0 | $1 | 0.01% |
| BLUE PACIFIC INSURANCE SERVICES3 | 18 SEPULVEDA RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | $0 | $1 | 0.01% |
| BENEFITS EXCHANGE ALLIANCE3 Filed as: BENEFITS EXCHANGE ALLIANCE INC | 23716 BIRTCHER DR LAKE FOREST, CA 92630 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $59 | $0 | $59 | 0.98% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA | DBA BXA INSURANCE SERVICES LAKE FOREST, CA 92630 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $58 | $0 | $58 | 0.97% |
| BRYSON INSURANCE AGENCY INC.3 Filed as: BRYSON INSURANCE AGENCY INC | 3777 LONG BEACH BLVD STE 500 LONG BEACH, CA 90807 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $49 | $0 | $49 | 0.82% |
| JOHN D EVANGELISTA3 Filed as: JOHN D. EVANGELISTA | 186 LAS FLORES ALISO VIEJO, CA 92656 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $40 | $0 | $40 | 0.67% |
| STACI MARIE FERRARIS3 | 28912 GLEN ROCK PLACE HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $36 | $0 | $36 | 0.60% |
| TIM CHRISTOPHER ELLIS3 | P.O. BOX 483 ORANGE, CA 92856 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $34 | $0 | $34 | 0.57% |
| TAMMY LYNN RANAHAN3 | 29356 STAGELINE CIR MENIFEE, CA 92584 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $27 | $0 | $27 | 0.45% |
| J&H FINANCIAL AND INSURANCE SVC LLC3 | 22948 VIA CEREZA UNIT 4E MISSION VIEJO, CA 92691 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $19 | $0 | $19 | 0.32% |
| MICHAEL F FAHEY III3 | 103 PALM DRIVE SAN CLEMENTE, CA 92672 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $15 | $0 | $15 | 0.25% |
| TECH COORDINATOR CYBER INSURANCE SO3 | 10741 LA JARA ST CERRITOS, CA 90703 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | $0 | $6 | 0.10% |
| MARIA YVONNE RODIGHIERO3 | 28502 SHRIKE DR LAGUNA NIGUEL, CA 92677 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | $0 | $3 | 0.05% |
| SARAH COURTNEY KNAPP3 | 61 SKLAR LADERA RANCH, CA 92694 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | $0 | $3 | 0.05% |
| MIKE MCCORMICK3 | 7 MONSERRAT PL. FOOTHILL RANCH, CA 92610 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | $0 | $3 | 0.05% |
| ASCENSION BENEFITS ADVISORS3 | 6 POMEGRANATE ST LADERA RANCH, CA 92694 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | $0 | $1 | 0.02% |
| MARIA C GONZALEZ3 | 11677 SANDPIPER CT MORENO VALLEY, CA 92557 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | $0 | $1 | 0.02% |
| MARIANNA REBECCA WEAVER3 | 20092 CHAMPLAIN LAKE FOREST, CA 92630 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | $0 | $1 | 0.02% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ACRISURE OF CALIFORNIA EIN 38-3942950 BROKER | Insurance agents and brokers Service code 22 | — | $0 |
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 | 491 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 491 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA HEALTH, INC. | 25 | $230K |
| Dental | GUARDIAN | 474 | $533K |
| Vision | GUARDIAN | 474 | $533K |
| Life insurance(3 contracts, 2 carriers) | GUARDIAN | 474 | $547K |
| Short-term disability | GUARDIAN | 474 | $533K |
| Long-term disability | GUARDIAN | 474 | $533K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 491 | — |
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.