| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NAC INSURANCE ADMINISTRATION CORPOR3 Filed as: NAC INSURANCE ADMINISTRATION CORP. | PO BOX 640 CAPITOLA, CA 95010 | CALIFORNIACHOICE | $53K | $0 | $53K | 5.00% |
| NAC INSURANCE ADMINISTRATION CORPOR3 Filed as: NAC INSURANCE ADMINISTRATION CORP. | PO BOX 640 CAPITOLA, CA 95010 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $570 | $7K | 13.08% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INS. SERVICES, INC. | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | $381 | $2K | 5.01% |
| NAC INSURANCE ADMINISTRATION CORPOR3 Filed as: NAC INSURANCE ADMINISTRATION CORP. | PO BOX 640 CAPITOLA, CA 95010 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | $0 | $2K | 4.99% |
| CAN INSURANCE SERVICES3 | 820 BAY AVENUE, SUITE 230 CAPITOLA, CA 95010 | CALIFORNIA DENTAL NETWORK | $2K | $0 | $2K | 10.00% |
| NAC INSURANCE ADMINISTRATION CORPOR3 Filed as: NAC INSURANCE ADMINISTRATION CORP. | PO BOX 640 CAPITOLA, CA 95010 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $1K | $0 | $1K | 9.06% |
| NAC INSURANCE ADMINISTRATION CORPOR3 Filed as: NAC INSURANCE ADMINISTRATION CORP. | PO BOX 640 CAPITOLA, CA 95010 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $0 | $1K | 15.01% |
| NAC INSURANCE ADMINISTRATION CORPOR3 Filed as: NAC INSURANCE ADMINISTRATION CORP. | 1500 41ST AVENUE, SUITE 228 CAPITOLA, CA 95010 | AFLAC | $757 | $0 | $757 | 7.96% |
| JOY E GUNDERSON3 Filed as: JOY E. GUNDERSON | 2824 SAINT ANDREWS ROAD FAIRFIELD, CA 94534 | AFLAC | $608 | $0 | $608 | 6.40% |
| JEFFERY WAYNE GUNDERSON3 | 2824 SAINT ANDREWS ROAD FAIRFIELD, CA 94534 | AFLAC | $261 | $262 | $523 | 5.50% |
| PATRICIA ANN BOSCH3 | 6816 HOMAN COURT CHINO, CA 91710 | AFLAC | $492 | $0 | $492 | 5.18% |
| JONATHAN ALI HAJIMOMEN3 | 6540 GRAND MANAN DRIVE CYPRESS, CA 90630 | AFLAC | $210 | $0 | $210 | 2.21% |
| NAC INSURANCE ADMINISTRATION CORPOR3 Filed as: NAC INSURANCE ADMINISTRATION CORP. | PO BOX 640 CAPITOLA, CA 95010 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $0 | $1K | 14.29% |
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 | 136 | 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) | 136 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIACHOICE | 133 | $1.1M |
| Dental(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 87 | $53K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 111 | $13K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 136 | $63K |
| Short-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 136 | $63K |
| Long-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 136 | $62K |
| Prescription drug | CALIFORNIACHOICE | 133 | $1.1M |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 136 | $63K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 136 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.