| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | P.O. BOX 62949 VIRGINIA BEACH, VA 234662949 | KAISER FOUNDATION HEALTH PLAN INC. | $38K | — | $38K | 3.60% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $22K | $11 | $22K | 2.09% |
| USI INSURANCE SERVICES LLC3 | 38 DISCOVERY SUITE 250 IRVINE, CA 92618 | CALIFORNIACHOICE | $3K | — | $3K | 3.76% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | CALIFORNIACHOICE | $2K | — | $2K | 2.72% |
| USI INSURANCE SERVICES LLC3 Filed as: USI OF SOUTHERN CALIFORNIA | 21700 OXNARD STREET SUITE 1200 WOODLAND HILLS, CA 91367 | DENTAL HEALTH SERVICES | $7K | — | $7K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | DENTAL HEALTH SERVICES | $3K | — | $3K | 4.36% |
| MCCAREY INC3 Filed as: MCCAREY INC. | 965 MESA DRIVE CAMARILLO, CA 93010 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $771 | $301 | $1K | 3.76% |
| USI INSURANCE SERVICES LLC3 | 27100 OXNARD STREET SUITE 1200 WOODLAND HILLS, CA 91367 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $806 | $14 | $820 | 2.88% |
| R & B ENROLLMENT SERVICES INC3 Filed as: R & B ENROLLMENT SERVICES INC. | P.O. BOX 3216 CRESTLINE, CA 92325 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $651 | $55 | $706 | 2.48% |
| ANDREA MARIE TIERCE3 | 2204 PLEASANTWOOD LANE ESCONDIDO, CA 92026 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $275 | $64 | $339 | 1.19% |
| VINCENT GERARD MCLAUGHLIN3 | 30310 HORSETHIEF DRIVE TEHACHAPI, CA 93561 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $75 | $138 | $213 | 0.75% |
| VGM BENEFIT ENROLLMENTS LLC3 | 30310HORSETHIEF DRIVE TEHACHAPI, CA 93561 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $104 | $48 | $152 | 0.53% |
| JOHN A. BRADLEY INC.3 | 207 S. MAIN STREET FOUNTAIN, SC 29644 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $133 | — | $133 | 0.47% |
| CALIFORNIA INSURANCE ADVOCATES INC3 Filed as: CALIFORNIA INSURANCE ADVOCATES INC. | 41960 AVENIDA DE ANITA TEMECULA, CA 92592 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $39 | — | $39 | 0.14% |
| DEL DOWNEY3 | 41960 AVENIDA DE ANITA TEMECULA, CA 92592 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $15 | — | $15 | 0.05% |
| T & R BENEFIT CONSULTANTS3 | P.O. BOX 292 RIMFOREST, CA 92378 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| THOMAS JOHN RHODES3 | P.O. BOX 292 RIMFOREST, CA 92378 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE & PRENTICE HOLDING COMPANY | 21700 OXNARD STREET SUITE 1200 WOODLAND HILLS, CA 913677578 | VISION SERVICE PLAN | $869 | — | $869 | 3.24% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | VISION SERVICE PLAN | $453 | — | $453 | 1.69% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES LLC - WEST | IRVINE OPCO P.O. BOX 62683 VIRGINIA BEACH, VA 234662683 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $866 | $3K | 13.31% |
| SANDRA R ROKOP3 Filed as: SANDRA ROKOP | 36471 ROYAL SAGE COURT PALM DESERT, CA 92211 | AFLAC | $930 | — | $930 | 5.51% |
| DONALD F WASINGER3 Filed as: DONALD F. WASINGER | 36471 ROYAL SAGE COURT PALM DESERT, CA 92211 | AFLAC | $561 | — | $561 | 3.33% |
| JANICE ADAMSON3 | 405 S. HIBISCUS WAY ANAHEIM, CA 92808 | AFLAC | $158 | — | $158 | 0.94% |
| DANIEL TYLER ADAMSON3 Filed as: DANIEL ADAMSON | 405 S. HIBISCUS WAY ANAHEIM, CA 92808 | AFLAC | $82 | — | $82 | 0.49% |
| G SCOTT COOKE3 Filed as: SCOTT BLACKSHEAR | 3453 CATHRYN DRIVE COLUMBUS, GA 31906 | AFLAC | $33 | — | $33 | 0.20% |
| JAMES P BOADA3 Filed as: JAMES BOADA | 30991 VIA MIRADOR SAN JUAN CAPOSTRANO, CA 92675 | AFLAC | $27 | — | $27 | 0.16% |
| TERRANCE M LUCZAJ3 Filed as: TERRANCE LUCZAJ | 435 HARRODS LANE CHARLESTON, SC 29412 | AFLAC | $19 | — | $19 | 0.11% |
| ANDREW R GRETHEL3 Filed as: ANDREW GRETHEL | 11739 HICKORY RUN COURT LOVELAND, OH 45140 | AFLAC | $12 | — | $12 | 0.07% |
| PEGGY K SALMON3 Filed as: PEGGY SALMON | 2203 AVENIDA OLIVA SAN CLEMENTE, CA 92673 | AFLAC | $10 | — | $10 | 0.06% |
| TOMMY C FLEESON3 Filed as: TOMMY FLEESON | 1300 SHEETER AVENUE APT. 1041 JACKSONVILLE BEACH, FL 32250 | AFLAC | $10 | — | $10 | 0.06% |
| AMANDA M GRIFFITH3 Filed as: AMANDA GRIFFITH | 11400 SE 8TH STREET SUITE 375 BELLEVUE, WA 98004 | AFLAC | $5 | — | $5 | 0.03% |
| JAMES J GRETHEL3 Filed as: JAMES GRETHEL | 865 CEDAR DRIVE LOVELAND, OH 45140 | AFLAC | $5 | — | $5 | 0.03% |
| JEFFREY T JOHNSON3 Filed as: JEFFREY JOHNSON | 27321 PROVIDENT ROAD AGOURA HILLS, CA 91301 | AFLAC | $4 | — | $4 | 0.02% |
| JOY E GUNDERSON3 Filed as: JOY GUNDERSON | 4531 VALLECITO LANE YORBA LINDA, CA 92886 | AFLAC | $4 | — | $4 | 0.02% |
| CHRIS BRANSON3 | 9209 COLBERG DRIVE AUSTIN, TX 78749 | AFLAC | $3 | — | $3 | 0.02% |
| DEBRA A WALDMAN3 Filed as: DEBRA WALDMAN | 4005 CALLE BENVENIDO SAN CLEMENTE, CA 92873 | AFLAC | $1 | — | $1 | 0.01% |
| VANZANTEN INSURANCE SERVICES INC3 Filed as: VANZANTEN INSURANCE SERVICES INC. | 40152 STOWE ROAD TEMECULA, CA 92591 | AFLAC | $1 | — | $1 | 0.01% |
| ALBERTO MARZULLO3 | 161 PINE COVE KYLE, TX 78640 | AFLAC | $1 | — | $1 | 0.01% |
| DIANN KRZCIOK3 | 2682 GRAND FORKS ROAD HENDERSON, NV 89052 | AFLAC | $1 | — | $1 | 0.01% |
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 | 159 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 159 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 187 | $1.2M |
| Dental | DENTAL HEALTH SERVICES | 235 | $68K |
| Vision | VISION SERVICE PLAN | 162 | $27K |
| Life insurance | AFLAC | 21 | $17K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 28 | $28K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 161 | $26K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 187 | $1.2M |
| Other(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 28 | $45K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 235 | — |
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.