| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 | 160 W SANTA CLARA STREET SUITE 450 SAN JOSE, CA 95113 | KAISER FOUNDATION HEALTH PLAN INC | $115K | $0 | $115K | 3.49% |
| HIXME INSURANCE SOLUTIONS, INC.3 Filed as: HIXME INSURANCE SOLUTIONS INC | 27489 AGOURA RD STE 100 AGOURA HILLS, CA 91301 | KAISER FOUNDATION HEALTH PLAN INC | $25K | $0 | $25K | 0.76% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 45263 | BLUE CROSS OF CALIFORNIA | $64K | $0 | $64K | 3.09% |
| HIXME INSURANCE SOLUTIONS, INC.3 Filed as: HIXME INSURANCE SOLUTIONS INC | 27489 AGOURA RD SUITE 100 AGOURA HILLS, CA 91301 | BLUE CROSS OF CALIFORNIA | $21K | $0 | $21K | 0.99% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | 2301 DUPORT DRIVE 2ND FLOOR IRVINE, CA 92612 | PREMIER ACCESS INSURANCE COMPANY | $6K | $0 | $6K | 1.65% |
| HIXME INSURANCE SOLUTIONS, INC.3 Filed as: HIXME INSURANCE SOLUTIONS INC | 5737 KANAN RD #635 SUITE 100 WESTLAKE VILLAGE, CA 91361 | PREMIER ACCESS INSURANCE COMPANY | $1K | $0 | $1K | 0.37% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 45263 | VISION SERVICE PLAN | $280 | $0 | $280 | 0.36% |
| HIXME INSURANCE SOLUTIONS, INC.3 Filed as: HIXME INSURANCE SOLUTIONS INC | 27489 AGOURA RD STE 100 AGOURA HILLS, CA 91301 | VISION SERVICE PLAN | $280 | $0 | $280 | 0.36% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 45263 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $3K | $7K | 10.96% |
| HIXME INSURANCE SOLUTIONS, INC.3 Filed as: HIXME INSURANCE SOLUTIONS INC | 27489 AGOURA RD STE 100 AGOURA HILLS, CA 91301 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 3.29% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 45263 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $3K | $7K | 11.45% |
| HIXME INSURANCE SOLUTIONS, INC.3 Filed as: HIXME INSURANCE SOLUTIONS INC | 27489 AGOURA RD STE 100 AGOURA HILLS, CA 91301 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 3.29% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 45263 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $2K | $5K | 10.02% |
| HIXME INSURANCE SOLUTIONS, INC.3 Filed as: HIXME INSURANCE SOLUTIONS INC | 27489 AGOURA RD STE 100 AGOURA HILLS, CA 91301 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 3.41% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | PO BOX 632886 CINCINNATI, OH 45263 | AFLAC | $637 | $0 | $637 | 2.00% |
| AMY EVANS3 | 14358 MAGNOLIA BLVD APT 103 SHERMAN OAKS, CA 91423 | AFLAC | $498 | $0 | $498 | 1.56% |
| BOBBY F STREI3 | 50 CALLE DE VIDA RANCHO SANTA MARGARITA, CA 92688 | AFLAC | $397 | $0 | $397 | 1.24% |
| MJR INSURANCE SERVICES LLC3 | 5805 SEPULVEDA BLVD STE 700 SHERMAN OAKS, CA 91411 | AFLAC | $322 | $58 | $380 | 1.19% |
| ALEXANDER G BAYER3 | 900 CAMINO REAL UNIT 202 REDONDO BEACH, CA 90277 | AFLAC | $218 | $0 | $218 | 0.68% |
| CAMERON J BELL3 | 2390 CRENSHAW BLVD STE 307 TORRANCE, CA 90501 | AFLAC | $143 | $0 | $143 | 0.45% |
| ALFRED RIETKERK3 | 3120 NE 47TH ST FT LAUDERDALE, FL 33308 | AFLAC | $142 | $0 | $142 | 0.45% |
| BRIAN G JAEGGI3 | 15607 W LILLI WAY VAN NUYS, CA 91406 | AFLAC | $135 | $0 | $135 | 0.42% |
| RENEE SUZANNE CORSO3 | 5805 SEPULVEDA BLVD STE 700 SHERMAN OAKS, CA 91411 | AFLAC | $111 | $23 | $134 | 0.42% |
| MICHELLE ANN DERAS3 | 5805 SEPULVEDA BLVD STE 700 SHERMAN OAKS, CA 91411 | AFLAC | $117 | $0 | $117 | 0.37% |
| RICHARD J KUNZ3 | 601 MONTGOMERY ST STE 1475 SAN FRANCISCO, CA 94111 | AFLAC | $112 | $0 | $112 | 0.35% |
| REGINALD QUEEN3 | 5805 SEPULVEDA BLVD STE 700 SHERMAN OAKS, CA 91411 | AFLAC | $42 | $49 | $91 | 0.29% |
| STACY BETH BAKER3 | 7748 SAUSALITO AVE WEST HILLS, CA 91304 | AFLAC | $76 | $0 | $76 | 0.24% |
| MARK HABER & ASSOC INC3 Filed as: MARK HALIM HABER | 9370 SKY PARK CT STE 250 SAN DIEGO, CA 92123 | AFLAC | $67 | $0 | $67 | 0.21% |
| ADAM H MICHAELS3 | 2922 CORDA LN LOS ANGELES, CA 92123 | AFLAC | $59 | $0 | $59 | 0.18% |
| WILLIAM ANDREWS3 Filed as: WILLIAM M ANDREWS | 5805 SEPULVEDA BLVD STE 700 SHERMAN OAKS, CA 91411 | AFLAC | $54 | $0 | $54 | 0.17% |
| REGINALD QUEEN3 | 13032 STANFORD AVE LOS ANGELES, CA 90059 | AFLAC | $54 | $0 | $54 | 0.17% |
| JOSEPH A BUZZELLO3 | 9018 BALBOA BLVD STE 254 NORTHRIDGE, CA 91325 | AFLAC | $51 | $0 | $51 | 0.16% |
| STEVEN R. JOHNSON3 Filed as: STEVEN R JOHNSON | 6167 BRISTOL PKWY STE 106 CULVER CITY, CA 90230 | AFLAC | $43 | $0 | $43 | 0.13% |
| CHRISTOPHER UNDERWOOD3 | 5805 SEPULVEDA BLVD STE 700 SHERMAN OAKS, CA 91411 | AFLAC | $23 | $14 | $37 | 0.12% |
| ADRIAN RYAN WILLIAMS3 | 991 AMBER DR CAMARILLO, CA 93010 | AFLAC | $35 | $0 | $35 | 0.11% |
| HANS ERIC ANDERSON3 | 6808 SAINT ESTABAN ST TUJUNGA, CA 91042 | AFLAC | $31 | $0 | $31 | 0.10% |
| JOHN L U SRY III3 | 4636 CAHUENGA BLVD APT 213 TOLUCA LAKE, CA 91602 | AFLAC | $30 | $0 | $30 | 0.09% |
| MOLOKAI MYLES HAND3 | 1409 S LAMAR ST APT 716 DALLAS, TX 75215 | AFLAC | $21 | $0 | $21 | 0.07% |
| CHRISTOPHER HAGER3 | 8021 TRUXTON AVE LOS ANGELES, CA 90045 | AFLAC | $18 | $0 | $18 | 0.06% |
| MICHAEL C WALKER3 Filed as: MICHAEL A STACHOWIAK | 321 N CLARK ST STE 625 CHICAGO, IL 60654 | AFLAC | $18 | $0 | $18 | 0.06% |
| CAMERON BELL3 | 2390 CRENSHAW BLVD STE 307 TORRANCE, CA 90501 | AFLAC | $16 | $0 | $16 | 0.05% |
| JOSEPH A NASCA3 | 28081 W MAPLE AVE BARRINGTON, IL 60010 | AFLAC | $13 | $0 | $13 | 0.04% |
| ALBERT JOHNSON JR3 | 1255 E ALTADENA DR ALTADENA, CA 91001 | AFLAC | $12 | $0 | $12 | 0.04% |
| SHELDON F SCHIFF3 Filed as: SHELDON SCHIFF | 120 BROADWAY STE 2900 NEW YORK, NY 10271 | AFLAC | $11 | $0 | $11 | 0.03% |
| RAYMOND J KOBER3 | 14107 20TH AVE STE 507 WHITESTONE, NY 11357 | AFLAC | $10 | $0 | $10 | 0.03% |
| MARSHALL CHARLES MCDONALD3 | 415 DAVIDSON GATEWAY DR APT 7 DAVIDSON, NC 28036 | AFLAC | $9 | $0 | $9 | 0.03% |
| EDDIE G COLE3 | 3232 W 99TH ST APT 5 INGLEWOOD, CA 90305 | AFLAC | $8 | $0 | $8 | 0.03% |
| GARY SCOTT NELLIS3 | 10607 1/2 WOODBRIDGE ST TOLUCA LAKE, CA 91602 | AFLAC | $8 | $0 | $8 | 0.03% |
| WILLIS TOWERS WATSON US LLC3 Filed as: JOSEPH H WILLIS JR | 1431 NE 55TH ST FORT LAUDERDALE, FL 33334 | AFLAC | $8 | $0 | $8 | 0.03% |
| LARA K GRANDE3 | 117 MORNING MIST LN FRANKLIN, TN 37064 | AFLAC | $6 | $0 | $6 | 0.02% |
| STEPHEN WHITE3 Filed as: STEPHEN P WHITE | 5 EMERALD LN MONTEBELLO, NY 10901 | AFLAC | $5 | $0 | $5 | 0.02% |
| OLENA K SHEA3 | 3 MITCHELL PL UNIT 18C NEW YORK, NY 10017 | AFLAC | $5 | $0 | $5 | 0.02% |
| KENNETH C MEIER CORP3 Filed as: KENNETH C MEIER | 11835 QUEENS BLVD STE 1403 FOREST HILLS, NY 11375 | AFLAC | $3 | $0 | $3 | 0.01% |
| TODD V MASON3 | 6164 LAWRENCE ST CYPRESS, CA 90630 | AFLAC | $1 | $0 | $1 | 0.00% |
| JOANNA G MATHERLY3 | 2000 GLEN ECHO RD STE 204 NASHVILLE, TN 37215 | AFLAC | $1 | $0 | $1 | 0.00% |
| HENRY SAUCEDA3 | 2268 ALPHA CIR LA VERNE, CA 91750 | AFLAC | $1 | $0 | $1 | 0.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 45263 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $313 | $207 | $520 | 11.05% |
| HIXME INSURANCE SOLUTIONS, INC.3 Filed as: HIXME INSURANCE SOLUTIONS INC | 27489 AGOURA RD STE 100 AGOURA HILLS, CA 91301 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $158 | $0 | $158 | 3.36% |
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 612 | $5.4M |
| Dental | PREMIER ACCESS INSURANCE COMPANY | 990 | $379K |
| Vision | VISION SERVICE PLAN | 523 | $78K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 531 | $125K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 57 | $5K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 531 | $50K |
| Other(4 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 531 | $207K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 990 | — |
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."
Final-filing indicator set. Plan is winding down; don't waste sales effort here.