| 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 | $174K | $22 | $174K | 5.33% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | AETNA HEALTH OF CALIFORNIA INC. | $96K | $0 | $96K | 5.30% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | SYMETRA LIFE INSURANCE COMPANY | $13K | $3K | $16K | 11.58% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $0 | $4K | 4.93% |
| FMLASOURCE INC5 | 455 NORTH CITYFRONT PLAZA DRIVE 13TH FLOOR CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $3K | $3K | 3.89% |
| PLANSOURCE BENEFIT ADMINISTRATION3 | PO BOX 1313 ORLANDO, FL 32802 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $2K | $2K | 2.68% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INS. CO. | $5K | $0 | $5K | 9.87% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 15901 RED HILL AVENUE TUSTIN, CA 92780 | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INS. CO. | $2K | $0 | $2K | 4.20% |
| JOHNSON RESOURCES3 | 10801 EAST HAPPY VALLEY ROAD UNIT 78 SCOTTSDALE, AZ 85255 | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INS. CO. | $1K | $0 | $1K | 2.34% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $180 | $3K | 17.66% |
| LONG TERM CARE SOLUTIONS, INC.3 Filed as: LONG TERM CARE SOLUTIONS | 14715 NE 95TH STREET, SUITE 200 REDMOND, WA 98052 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $949 | $0 | $949 | 5.55% |
| USI INSURANCE SERVICES LLC3 | 7535 IRVINE CENTER DRIVE IRVINE, CA 92618 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $239 | $9 | $248 | 1.45% |
| PLANSOURCE BENEFIT ADMINISTRATION3 | PO BOX 1313 ORLANDO, FL 32802 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $86 | $0 | $86 | 0.50% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $137 | $2K | 12.69% |
| USI INSURANCE SERVICES LLC3 | 7535 IRVINE CENTER DRIVE, SUITE 250 IRVINE, CA 92618 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $643 | $61 | $704 | 5.37% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS SVCS | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $170 | $0 | $170 | 1.30% |
| PLANSOURCE BENEFIT ADMINISTRATION3 | PO BOX 1313 ORLANDO, FL 32802 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $130 | $0 | $130 | 0.99% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | PO BOX 6030 PASADENA, CA 91102 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $30 | $0 | $30 | 0.23% |
| STEVE BAKER4 | 153 ESTHER DRIVE COCOA BEACH, FL 32931 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $2K | $0 | $2K | 18.89% |
| HUB INTERNATIONAL MIDWEST LIMITED4 Filed as: BOLTON & COMPANY | PO BOX 6030 PASADENA, CA 91102 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $27 | $0 | $27 | 0.34% |
| DOMINISC NACCHIA4 | 201 CAROLINA POINT PARKWAY GREENVILLE, SC 29607 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $22 | $0 | $22 | 0.27% |
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 | 491 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 7 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 504 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 369 | $5.1M |
| Dental | AETNA LIFE INSURANCE COMPANY | 369 | $3.3M |
| Vision | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INS. CO. | 586 | $48K |
| Life insurance(2 contracts, 2 carriers) | SYMETRA LIFE INSURANCE COMPANY | 491 | $222K |
| Short-term disability(2 contracts, 2 carriers) | SYMETRA LIFE INSURANCE COMPANY | 491 | $150K |
| Long-term disability(2 contracts, 2 carriers) | SYMETRA LIFE INSURANCE COMPANY | 491 | $222K |
| Prescription drug(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 369 | $5.1M |
| Other(4 contracts, 4 carriers) | SYMETRA LIFE INSURANCE COMPANY | 491 | $247K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 586 | — |
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.