| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE SUITE 1200 IRVINE, CA 92612 | BLUE CROSS OF CALIFORNIA | $88K | $1K | $90K | 2.62% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | BLUE CROSS OF CALIFORNIA | $88K | — | $88K | 2.58% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $17K | $9 | $17K | 3.18% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DR., SUITE 1200 IRVINE, CA 926120304 | KAISER FOUNDATION HEALTH PLAN INC. | $14K | $1K | $15K | 2.81% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DR. SUITE 1200 IRVINE, CA 926120304 | METROPOLITAN LIFE INSURANCE COMPANY | $27K | $15K | $42K | 10.19% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | METROPOLITAN LIFE INSURANCE COMPANY | $22K | $6K | $29K | 6.89% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $3K | $8 | $3K | 3.35% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DR., SUITE 1200 IRVINE, CA 926120304 | KAISER FOUNDATION HEALTH PLAN INC. | $1K | $194 | $2K | 1.82% |
| BRIAN YERVANT AKIAN3 | 503 SPRINGBROOK NORTH IRVINE, CA 92614 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $167 | $2K | 8.60% |
| BURNHAM BENEFITS INSURANCE SERVICES3 Filed as: BURNHAM BENEFITS INS. SVCS. | 2211 MICHELSON DR. IRVINE, CA 92612 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 7.16% |
| JOHN D EVANGELISTA3 Filed as: JOHN D. EVENGELISTA | 26111 ANTONIO PARKWAY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $230 | $128 | $358 | 1.96% |
| MICHAEL F FAHEY III3 Filed as: MICHAEL F. FAHEY III | 411 AVENIDA ADOBE SAN CLEMENTE, CA 92672 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $252 | $40 | $292 | 1.60% |
| CONSUMER DRIVEN BENEFITS LLC3 | 3737 BIRCH ST. NEWPORT BEACH, CA 92660 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $27 | $26 | $53 | 0.29% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $18 | — | $18 | 0.10% |
| BENJAMIN ACEVEDO3 | 16211 E. GROVECENTER ST. COVINA, CA 91722 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | — | $12 | 0.07% |
| BURNHAM BENEFITS INSURANCE SERVICES3 Filed as: BURNHAM BENEFITS INS. SVCS. | 2211 MICHELSON DR. SUITE 1200 IRVINE, CA 926120304 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $465 | $286 | $751 | 7.73% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $418 | $176 | $594 | 6.12% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | GERBER LIFE INSURANCE COMPANY | $371 | — | $371 | 14.99% |
| PHYLLIS JOY4 | SELZNICK BLITZ 21115 KNIGHTS GLN LAKE FOREST, CA 92630 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $147 | — | $147 | 31.28% |
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 | 395 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 13 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 408 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 395 | $4.0M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 1,129 | $426K |
| Vision(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 1,129 | $1.0M |
| Life insurance | BLUE CROSS OF CALIFORNIA | 395 | $3.4M |
| Short-term disability | BLUE CROSS OF CALIFORNIA | 395 | $3.4M |
| Long-term disability | BLUE CROSS OF CALIFORNIA | 395 | $3.4M |
| Other(4 contracts, 4 carriers) | BLUE CROSS OF CALIFORNIA | 395 | $3.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,129 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.