| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BB&H BENEFIT DESIGNS3 | 109 E. VICTORIA ST SANTA BARBARA, CA 93101 | ANTHEM BLUE CROSS | $49K | — | $49K | 30.73% |
| CENTERSTONE INSURANCE AND FINANCIAL3 | 12404 PARK CENTRAL DR STE 400S DALLAS, TX 75251 | ANTHEM BLUE CROSS | — | $40K | $40K | 25.40% |
| ADSH INVESTMENTS3 Filed as: ADSH INVESTMENTS II INC | 23716 BIRTCHER DR LAKE FOREST, CA 92630 | CONTINENTAL AMERICAN INSURANCE CO | $2K | — | $2K | 3.75% |
| ERICA GOLDEN3 | 430 W. HARVARD ST, APT C GLENDALE, CA 91204 | CONTINENTAL AMERICAN INSURANCE CO | $2K | — | $2K | 3.62% |
| BB&H BENEFIT DESIGNS3 | 109 E. VICTORIA ST SANTA BARBARA, CA 93101 | CONTINENTAL AMERICAN INSURANCE CO | $1K | — | $1K | 2.26% |
| ANNETTE L. BURNS3 Filed as: ANNETTE L BURNS | 28303 BRYCE DR CASTAIC, CA 91384 | CONTINENTAL AMERICAN INSURANCE CO | $746 | — | $746 | 1.40% |
| STEVE SERVI3 | 6127 S. RAINBOW BLVD, 110 LAS VEGAS, NV 89118 | CONTINENTAL AMERICAN INSURANCE CO | $571 | — | $571 | 1.07% |
| VERONICA INCHAURREGUI3 | 800 WILSHIRE BLVD SUITE 200 LOS ANGELES, CA 90017 | CONTINENTAL AMERICAN INSURANCE CO | $560 | — | $560 | 1.05% |
| PATRICIA GAIL LEES3 Filed as: PATRICIA LEES | 1124 CHURCHS ST BURBANK, CA 91505 | CONTINENTAL AMERICAN INSURANCE CO | $478 | — | $478 | 0.90% |
| LILY FREGOSO3 | 3324 W. VERDUGO BURBANK, CA 91505 | CONTINENTAL AMERICAN INSURANCE CO | $380 | — | $380 | 0.71% |
| SHEM J BOSTICK3 Filed as: SHEM BOSTICK | 1325 MT. HERMON RD, #73B SALISBURY, MD 21804 | CONTINENTAL AMERICAN INSURANCE CO | $324 | — | $324 | 0.61% |
| CASS AND JOHANSING3 | 825 COLORADO BLVD, STE 215 LOS ANGELES, CA 90041 | CONTINENTAL AMERICAN INSURANCE CO | $215 | — | $215 | 0.40% |
| JACOB BURNS INC.3 Filed as: JACOB BURNS, INC | 12121 WILSHIRE BLVD, STE 1000 LOS ANGELES, CA 90025 | CONTINENTAL AMERICAN INSURANCE CO | $196 | — | $196 | 0.37% |
| LUZ SERVI3 | 2349 SALEROS O DR UPLAND, CA 91748 | CONTINENTAL AMERICAN INSURANCE CO | $176 | — | $176 | 0.33% |
| TODD V MASON3 Filed as: TODD V. MASON | 110 PINE AVE 3710 LONG BEACH, CA 90802 | CONTINENTAL AMERICAN INSURANCE CO | $132 | — | $132 | 0.25% |
| DORA BOSTICK3 | 1325 MT. HERMON RD SALISBURY, MD 21804 | CONTINENTAL AMERICAN INSURANCE CO | $118 | — | $118 | 0.22% |
| OSCAR FREGOSO3 | 340 E 2ND ST, STE 310 LOS ANGELES, CA 90012 | CONTINENTAL AMERICAN INSURANCE CO | $103 | — | $103 | 0.19% |
| HERACLIO ORTIZ3 | 26015 CYPRESS ST, 41 LOMITA, CA 90717 | CONTINENTAL AMERICAN INSURANCE CO | $68 | — | $68 | 0.13% |
| GLADYS N VIDES3 | 6055 E. WASHINGTON BLVD,#460 COMMERCE, CA 91722 | CONTINENTAL AMERICAN INSURANCE CO | $61 | — | $61 | 0.11% |
| CARLA BAGDASARYAN3 | 316 W 2ND,#500 LOS ANGELES, CA 90012 | CONTINENTAL AMERICAN INSURANCE CO | $60 | — | $60 | 0.11% |
| DAVID REESOR3 | 615 WILSON AVE UPLAND, CA 91784 | CONTINENTAL AMERICAN INSURANCE CO | $44 | — | $44 | 0.08% |
| ELLEN G VALDEZ3 | 340 E. 2ND ST, STE 310 LOS ANGELES, CA 91604 | CONTINENTAL AMERICAN INSURANCE CO | $42 | — | $42 | 0.08% |
| JOANNA G MATHERLY3 Filed as: JOANNA G PEOPLE | 2000 GLEN ECHO RD, STE 204 NASHVILLE, TN 37215 | CONTINENTAL AMERICAN INSURANCE CO | $37 | — | $37 | 0.07% |
| RAVONE M GRAHAM3 | 5329 PASEO GILBERTO YORBA LINDA, CA 92886 | CONTINENTAL AMERICAN INSURANCE CO | $34 | — | $34 | 0.06% |
| KENNETH B MCPHERSON3 | 3 ROSELEAF IRVINE, CA 92620 | CONTINENTAL AMERICAN INSURANCE CO | $18 | — | $18 | 0.03% |
| NANETTE STARK3 | 11618 LA MAIDA ST NORTH HOLLYWOOD, CA 91601 | CONTINENTAL AMERICAN INSURANCE CO | $14 | — | $14 | 0.03% |
| FRANSOISE Y KORENBERG3 | 6055 E. WASHINGTON BLVD, STE 460 COMMERCE, CA 90040 | CONTINENTAL AMERICAN INSURANCE CO | $12 | — | $12 | 0.02% |
| LINDA M NAPOLI3 Filed as: LINDA NAPOLI | 2881 NE 32ND ST FT. LAUDERDALE, FL 33306 | CONTINENTAL AMERICAN INSURANCE CO | $11 | — | $11 | 0.02% |
| MAX-JOSEPH H MONTEL3 | 948 WILCOX AVE 34 LOS ANGELES, CA 90038 | CONTINENTAL AMERICAN INSURANCE CO | $11 | — | $11 | 0.02% |
| OWEN JOHNSTON3 | 796 N. HART ST ORANGE, CA 92867 | CONTINENTAL AMERICAN INSURANCE CO | $8 | — | $8 | 0.02% |
| LABAN M. SPALDING3 Filed as: LABAN M SPALDING | 4297 KLUME AVE STUDIO CITY, CA 91602 | CONTINENTAL AMERICAN INSURANCE CO | $7 | — | $7 | 0.01% |
| LIVIER MARIA RAMIREZ3 Filed as: LIVIER RAMIREZ | 2101 TOLDEDO ST LOS ANGELES, CA 90042 | CONTINENTAL AMERICAN INSURANCE CO | $5 | — | $5 | 0.01% |
| NANCY CALDERON3 | 6210 BEAR AVE BELL, CA 90201 | CONTINENTAL AMERICAN INSURANCE CO | $2 | — | $2 | 0.00% |
| ERICA GOLDEN3 | 430 HARVARD ST, APT C GLENDALE, CA 91204 | AFLAC | $302 | — | $302 | 3.97% |
| ADSH INVESTMENTS3 Filed as: ADSH INVESTMENTS II INC | 23716 BIRTCHER DR LAKE FOREST, CA 92630 | AFLAC | $152 | — | $152 | 2.00% |
| DORA BOSTICK3 | 1620 DITMAR ST OCEANSIDE, CA 92054 | AFLAC | $152 | — | $152 | 2.00% |
| LILY FREGOSO3 | 25750 LEWIS WAY STEVENSON RANCH, CA 91381 | AFLAC | $74 | — | $74 | 0.97% |
| ELLEN G VALDEZ3 | 20016 BLYTHE ST WINNETKA, CA 91306 | AFLAC | $12 | — | $12 | 0.16% |
| CARLA BAGDASARYAN3 | 2879 W. MIRA DRIVE QUEEN CREEK, AZ 85142 | AFLAC | $6 | — | $6 | 0.08% |
| ADSH INVESTMENTS3 | 23716 BIRTCHER DR LAKE FOREST, CA 92630 | HARTFORD LIFE AND ACCIDENT | $374 | — | $374 | 11.99% |
| ACRISURE LLC3 | 6307 84TH ST SE CALEDONIA, MI 49316 | HARTFORD LIFE AND ACCIDENT | — | $38 | $38 | 1.22% |
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 | 103 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 105 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CA | 82 | $918K |
| Dental | ANTHEM BLUE CROSS | 103 | $159K |
| Vision | ANTHEM BLUE CROSS | 103 | $159K |
| Life insurance(3 contracts, 3 carriers) | ANTHEM BLUE CROSS | 298 | $215K |
| Long-term disability(2 contracts, 2 carriers) | ANTHEM BLUE CROSS | 211 | $162K |
| Prescription drug | BLUE CROSS OF CA | 82 | $918K |
| Other(2 contracts, 2 carriers) | AFLAC | 211 | $11K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 298 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
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.