| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PENBEN FINANCIAL SERVICES INC. DBA3 Filed as: PENBEN FINANCIAL SERVICES INC | DBA BXA INSURANCE SERVICES 3744 MT DIABLO BLVD, SUITE 205 LAFAYETTE, CA 94549 | AETNA HEALTH INC | $62K | — | $62K | 4.81% |
| BENEFITS EXCHANGE ALLIANCE3 Filed as: BENEFITS EXCHANGE ALLIANCE INC | 23716 BIRTCHER DR LAKE FOREST, CA 92630 | GUARDIAN LIFE INS CO OF AMERICA | $4K | — | $4K | 3.39% |
| PENBEN FINANCIAL SERVICES INC. DBA3 Filed as: PENBEN FINANCIAL SERVICES INC DBA | BSA INSURANCE SERVICES 3744 MT. DIABLO BLVD SUITE 205 LAFAYETTE, CA 94549 | AETNA LIFE INSURANCE CO. | $5K | — | $5K | 5.41% |
| ERICA GOLDEN3 | 430 HARVARD ST, APT C GLENDALE, CA 91204 | CONTINENTAL AMERICAN INSURANCE CO | $4K | — | $4K | 6.26% |
| ADSH INVESTMENTS3 Filed as: ADSH INVESTMENTS II INC | 23716 BIRTCHER DR LAKE FOREST, CA 92630 | CONTINENTAL AMERICAN INSURANCE CO | $3K | — | $3K | 5.89% |
| VERONICA INCHAURREGUI3 | 800 WILSHIRE BLVD STE 200 LOS ANGELES, CA 90017 | CONTINENTAL AMERICAN INSURANCE CO | $2K | — | $2K | 3.58% |
| STEVE D SERVI3 | 6127 S RAINBOW BLVD 110 LAS VEGAS, NV 89118 | CONTINENTAL AMERICAN INSURANCE CO | $597 | — | $597 | 1.04% |
| PATRICIA GAIL LEES3 Filed as: PATRICIA G LEES | 1124 CHURCHS CT BURBANK, CA 91501 | CONTINENTAL AMERICAN INSURANCE CO | $589 | — | $589 | 1.02% |
| SHEM J BOSTICK3 Filed as: SHEM J. BOSTICK | 1325 MT. HERMON RD, #73B SALISBURY, MD 21804 | CONTINENTAL AMERICAN INSURANCE CO | $547 | — | $547 | 0.95% |
| ERICA GOLDEN3 Filed as: ERICA R GOLDEN | 430 W HARVARD ST APT C GLENDALE, CA 91204 | CONTINENTAL AMERICAN INSURANCE CO | $516 | — | $516 | 0.90% |
| HERACLIO ORTIZ3 | 26015 CYPRESS ST 41 LOMITA, CA 90717 | CONTINENTAL AMERICAN INSURANCE CO | $278 | — | $278 | 0.48% |
| CASS AND JOHANSING3 | 825 COLORADO BLVD STE 215 LOS ANGELES, CA 90041 | CONTINENTAL AMERICAN INSURANCE CO | $225 | — | $225 | 0.39% |
| DORA BOSTICK3 Filed as: DORA I BOSTICK | 1325 MOUNT HERMON RD SALISBURY, MD 21804 | CONTINENTAL AMERICAN INSURANCE CO | $192 | — | $192 | 0.33% |
| LUZ ELENA SERVI3 Filed as: LUZ E SERVI | 2349 SALEROSO DR ROWLAND HEIGHTS, CA 91748 | CONTINENTAL AMERICAN INSURANCE CO | $176 | — | $176 | 0.31% |
| TODD V MASON3 | 110 PINE AVE 3710 LONG BEACH, CA 90802 | CONTINENTAL AMERICAN INSURANCE CO | $138 | — | $138 | 0.24% |
| LILY FREGOSO3 | 3324 W VERDUGO AVE BURBANK, CA 91505 | CONTINENTAL AMERICAN INSURANCE CO | $120 | — | $120 | 0.21% |
| ELLEN G VALDEZ3 Filed as: ELLEN VALDEZ | 340 E 2ND ST #310 LOS ANGELES, CA 91604 | CONTINENTAL AMERICAN INSURANCE CO | $112 | — | $112 | 0.19% |
| CARLA BAGDASARYAN3 | 316 W 2ND #500 LOS ANGELES, CA 90012 | CONTINENTAL AMERICAN INSURANCE CO | $92 | — | $92 | 0.16% |
| GLADYS N VIDES3 | 6055 EAST WASHINGTON BLVD #460 COMMERCE, CA 91722 | CONTINENTAL AMERICAN INSURANCE CO | $64 | — | $64 | 0.11% |
| DAVID REESOR3 | 1615 WILSON AVE UPLAND, CA 91784 | CONTINENTAL AMERICAN INSURANCE CO | $62 | — | $62 | 0.11% |
| RAVONE M GRAHAM3 | 5329 PASEO GILBERTO YORBA LINDA, CA 92886 | CONTINENTAL AMERICAN INSURANCE CO | $57 | — | $57 | 0.10% |
| NANETTE STARK3 | 11618 LA MAIDA ST NORTH HOLLYWOOD, CA 91601 | CONTINENTAL AMERICAN INSURANCE CO | $49 | — | $49 | 0.09% |
| JOANNA G MATHERLY3 Filed as: JOANNA G PEOPLE | 2000 GLEN ECHO RD, STE 204 NASHVILLE, TN 37215 | CONTINENTAL AMERICAN INSURANCE CO | $42 | — | $42 | 0.07% |
| MAX-JOSEPH H MONTEL3 | 948 WILCOX AVE 34 LOS ANGELES, CA 90038 | CONTINENTAL AMERICAN INSURANCE CO | $39 | — | $39 | 0.07% |
| OSCAR FREGOSO3 | 340 E 2ND ST STE 310 LOS ANGELES, CA 90012 | CONTINENTAL AMERICAN INSURANCE CO | $31 | — | $31 | 0.05% |
| KENNETH B MCPHERSON3 | 3 ROSELEAF IRVINE, CA 92620 | CONTINENTAL AMERICAN INSURANCE CO | $30 | — | $30 | 0.05% |
| LABAN M. SPALDING3 Filed as: LABAN M SPALDING | 4297 KLUME AVE STUDIO CITY, CA 91602 | CONTINENTAL AMERICAN INSURANCE CO | $23 | — | $23 | 0.04% |
| FRANCOISE YVONNE KORENBERG3 Filed as: FRANCOISE Y KORENBERG | 6055 E WASHINGTON BLVD SUITE 460 COMMERCE, CA 90040 | CONTINENTAL AMERICAN INSURANCE CO | $15 | — | $15 | 0.03% |
| OWEN JOHNSTON3 | 796 N HART ST ORANGE, CA 92876 | CONTINENTAL AMERICAN INSURANCE CO | $11 | — | $11 | 0.02% |
| LINDA M NAPOLI3 | 2881 NE 32ND ST APT 120 FT LAUDERDALE, FL 33306 | CONTINENTAL AMERICAN INSURANCE CO | $11 | — | $11 | 0.02% |
| LIVIER MARIA RAMIREZ3 Filed as: LIVIER RAMIREZ | 2101 TOLEDO ST LOS ANGELES, CA 90042 | CONTINENTAL AMERICAN INSURANCE CO | $6 | — | $6 | 0.01% |
| NANCY CALDERON3 | 6210 BEAR AVE BELL, CA 90201 | CONTINENTAL AMERICAN INSURANCE CO | $2 | — | $2 | 0.00% |
| ADSH INVESTMENTS3 | 23716 BIRTCHER DR LAKE FOREST, CA 92630 | HARTFORD LIFE AND ACCIDENT | $3K | — | $3K | 12.00% |
| SCIROCCO GROUP3 | 307 84TH ST SE CALEDONIA, MI 49316 | HARTFORD LIFE AND ACCIDENT | $0 | $277 | $277 | 1.04% |
| BENEFITS EXCHANGE ALLIANCE3 | 23716 BIRTCHER DR LAKE FOREST, CA 92630 | VISION SERVICE PLAN | $1K | — | $1K | 5.24% |
| ERICA GOLDEN3 | 800 WILSHIRE BLVD, STE 200 LOS ANGELES, CA 90017 | AFLAC | $418 | $25 | $443 | 4.59% |
| DORA BOSTICK3 | 1620 S. DITMAR ST OCEANSIDE, CA 92054 | AFLAC | $199 | $10 | $209 | 2.17% |
| MICHAEL REZINAS3 | 15455 SAN FERNANDO MISSION BLVD SUITE 407 MISSION HILLS, CA 91345 | AFLAC | $153 | — | $153 | 1.59% |
| LILY FREGOSO3 | 3324 W VERDUGO AVE BURBANK, CA 91505 | AFLAC | $96 | $8 | $104 | 1.08% |
| ADSH INVESTMENTS3 Filed as: ADSH INVESTMENTS II INC | 23716 BIRTCHER DR LAKE FOREST, CA 92630 | AFLAC | $59 | — | $59 | 0.61% |
| ELLEN G VALDEZ3 | 4339 RADFORD AVE APT4 STUDIO CITY, CA 91604 | AFLAC | $38 | $16 | $54 | 0.56% |
| CARLA BAGDASARYAN3 | 2879 W MIRA DR QUEEN CREEK, AZ 85142 | AFLAC | $15 | $11 | $26 | 0.27% |
| ELLEN G VALDEZ3 | 20016 BLYTHE ST WINNETKA, CA 91306 | AFLAC | $6 | — | $6 | 0.06% |
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 | 211 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 211 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE CO. | 7 | $92K |
| Dental | GUARDIAN LIFE INS CO OF AMERICA | 151 | $106K |
| Vision | VISION SERVICE PLAN | 143 | $20K |
| Life insurance(3 contracts, 3 carriers) | AETNA LIFE INSURANCE CO. | 211 | $128K |
| Long-term disability(2 contracts, 2 carriers) | AETNA LIFE INSURANCE CO. | 211 | $118K |
| Other(4 contracts, 4 carriers) | AETNA LIFE INSURANCE CO. | 296 | $178K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 296 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.