| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | AETNA LIFE INSURANCE COMPANY | $89K | $0 | $89K | 3.03% |
| USI INSURANCE SERVICES LLC3 | 21250 HAWTHORNE BOULEVARD TORRANCE, CA 90503 | AETNA LIFE INSURANCE COMPANY | $41K | $13K | $54K | 1.85% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | AETNA HEALTH OF CALIFORNIA INC. | $47K | $0 | $47K | 2.96% |
| USI INSURANCE SERVICES LLC3 | 21250 HAWTHORNE BOULEVARD TORRANCE, CA 90503 | AETNA HEALTH OF CALIFORNIA INC. | $30K | $0 | $30K | 1.85% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $11K | $14K | $24K | 11.15% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $22K | $0 | $22K | 10.20% |
| FMLASOURCE INC5 | 455 NORTH CITYFRONT PLAZA DRIVE 13TH FLOOR CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $8K | $8K | 3.68% |
| PLANSOURCE BENEFITS ADMINISTRATION5 Filed as: PLANSOURCE BENEFIT ADMIN INC | PO BOX 1313 ORLANDO, FL 32802 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $6K | $6K | 2.54% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 15901 RED HILL AVENUE TUSTIN, CA 92780 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $3K | $0 | $3K | 7.05% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $2K | $0 | $2K | 3.22% |
| JOHNSON RESOURCES3 | 10801 EAST HAPPY VALLEY ROAD SUITE 78 SCOTTSDALE, AZ 85255 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $815 | $0 | $815 | 1.66% |
| JOHNSON RESOURCES3 | 7373 EAST DOUBLETREE RANCH SUITE 200 SCOTTSDALE, AZ 85258 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $78 | $0 | $78 | 0.16% |
| USI INSURANCE SERVICES LLC3 | 7535 IRVINE CENTER DRIVE, SUITE 250 IRVINE, CA 92618 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $7K | $1K | $9K | 43.58% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $752 | $68 | $820 | 4.19% |
| PLANSOURCE BENEFITS ADMINISTRATION3 Filed as: PLANSOURCE BENEFIT ADMIN INC | PO BOX 1313 ORLANDO, FL 32802 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $427 | $0 | $427 | 2.18% |
| SULLIVANCURTISMONROE INS SVCS LLC3 Filed as: SULLIVANCURTISMONROE INS | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $273 | $0 | $273 | 1.40% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | PO BOX 6030 PASADENA, CA 91102 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $61 | $0 | $61 | 0.31% |
| USI INSURANCE SERVICES LLC3 | PO BOX 9004 VAN NUYS, CA 91409 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | -$3K | $0 | -$3K | -15.93% |
| USI INSURANCE SERVICES LLC3 | 7535 IRVINE CENTER DRIVE, SUITE 250 IRVINE, CA 92618 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $398 | $6K | 59.52% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $68 | $1K | 11.44% |
| PLANSOURCE BENEFITS ADMINISTRATION3 Filed as: PLANSOURCE BENEFIT ADMIN INC | PO BOX 1313 ORLANDO, FL 32802 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $198 | $0 | $198 | 1.98% |
| SULLIVANCURTISMONROE INS SVCS LLC3 Filed as: SULLIVANCURTISMONROE INS | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3 | $0 | $3 | 0.03% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | PO BOX 6030 PASADENA, CA 91102 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2 | $0 | $2 | 0.02% |
| USI INSURANCE SERVICES LLC3 | PO BOX 9004 VAN NUYS, CA 91409 | UNUM LIFE INSURANCE COMPANY OF AMERICA | -$4K | $0 | -$4K | -35.91% |
| STEVE BAKER4 | 153 ESTHER DRIVE COCOA BEACH, FL 32931 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $2K | $0 | $2K | 16.83% |
| HUB INTERNATIONAL MIDWEST LIMITED4 Filed as: BOLTON & COMPANY | PO BOX 6030 PASADENA, CA 91102 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $27 | $0 | $27 | 0.28% |
| DOMINIC A. NACCHIA4 Filed as: DOMINIC A NACCHIA | 201 CAROLINA POINT PARKWAY APARTMENT 206 GREENVILLE, SC 29607 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $22 | $0 | $22 | 0.23% |
| LONG TERM CARE SOLUTIONS, INC.3 Filed as: LONG TERM CARE SOLUTIONS INC | 14715 NE 95TH STREET, SUITE 200 REDMOND, WA 98052 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $858 | $0 | $858 | 11.26% |
| USI INSURANCE SERVICES LLC3 | 7535 IRVINE CENTER DRIVE, SUITE 250 IRVINE, CA 92618 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $366 | $0 | $366 | 4.80% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $227 | $0 | $227 | 2.98% |
| USI INSURANCE SERVICES LLC3 | UNKNOWN CARSON, CA 90746 | UNUM LIFE INSURANCE COMPANY OF AMERICA | -$308 | $0 | -$308 | -4.04% |
| PLANSOURCE BENEFITS ADMINISTRATION3 Filed as: PLANSOURCE BENEFIT ADMIN INC | PO BOX 1313 ORLANDO, FL 32802 | FIRST UNUM LIFE INSURANCE COMPANY | $5 | $0 | $5 | — |
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 | 457 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 10 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 472 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 359 | $4.5M |
| Dental | AETNA LIFE INSURANCE COMPANY | 359 | $2.9M |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 528 | $49K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 457 | $219K |
| Short-term disability(2 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 82 | $20K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 457 | $219K |
| Prescription drug(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 359 | $4.5M |
| Other(4 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 457 | $246K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 528 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.