| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | HEALTH NET | $24K | — | $24K | 5.32% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $19K | — | $19K | 11.96% |
| ROGERS BENEFIT GROUP INC3 | 5110 N 40TH STREET SUITE 234 PHOENIX, AZ 85018 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $4K | — | $4K | 2.35% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES INC | 2393 TOWNSGATE RD STE 101 WESTLAKE VILLAGE, CA 91361 | AFLAC | $419 | — | $419 | 3.83% |
| AMY EVANS3 | 4932 N NORTH MAYWOOD AVE LOS ANGELES, CA 90041 | AFLAC | $202 | — | $202 | 1.85% |
| RENEE SUZANNE CORSO3 | 5805 SEPULVEDA BLVD STE 700 SHERMAN OAKS, CA 91411 | AFLAC | $178 | — | $178 | 1.63% |
| YOLANDA JOY RICHMAN3 | 10000 NEVADA AVE SHERMAN OAKS, CA 91411 | AFLAC | $178 | — | $178 | 1.63% |
| NASHINA BUSH3 | 7555 DONNA AVE RESEDA, CA 91335 | AFLAC | $79 | — | $79 | 0.72% |
| RICHARD J KUNZ3 | 601 MONTGOMERY ST STE 1475 SAN FRANCISCO, CA 94111 | AFLAC | $63 | — | $63 | 0.58% |
| CHRISTOPHER EVANS3 | 1384 OAKLAND BLVD APT 8 WALNUT CREEK, CA 94596 | AFLAC | $53 | — | $53 | 0.48% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 10531 4S COMMONS DR STE 166-516 SAN DIEGO, CA 92127 | AFLAC | $49 | — | $49 | 0.45% |
| ADAM H MICHAELS3 Filed as: ADAM MICHAELS | 2922 CORDA LN LOS ANGELES, CA 90049 | AFLAC | $47 | — | $47 | 0.43% |
| BRIAN GEORGE JAEGGI3 | 8591 DYNASTY DR BOCA RATON, FL 33433 | AFLAC | $44 | — | $44 | 0.40% |
| SHARON S. WIENER3 Filed as: SHARON S WIENER | 8833 PICKFORD ST LOS ANGELES, CA 90035 | AFLAC | $23 | — | $23 | 0.21% |
| DINORA ROSSANA DEVALLY3 | 361 MISTY TRAILS PL SIMI VALLEY, CA 93065 | AFLAC | $20 | — | $20 | 0.18% |
| LILY YAN3 | 5805 SEPULVEDA BLVD STE 700 SHERMAN OAKS, CA 91411 | AFLAC | $12 | — | $12 | 0.11% |
| CHRISTOPHER HAGER3 | 8021 TRUXTON AVE LOS ANGELES, CA 90045 | AFLAC | $12 | — | $12 | 0.11% |
| MICHELE BARBARA COSTA3 | 8117 W 4TH ST LOS ANGELES, CA 90048 | AFLAC | $8 | — | $8 | 0.07% |
| MICHAEL C WALKER3 Filed as: MICHAEL A STACHOWIAK | 321 N CLARK ST STE 615 CHICAGO, IL 60654 | AFLAC | $6 | — | $6 | 0.05% |
| JOSEPH A BUZZELLO3 | 14747 N NORTHSIGHT BLVD STE 111-454 SCOTTSDALE, AZ 85260 | AFLAC | $6 | — | $6 | 0.05% |
| JOANN SONG ZWAGERMAN3 | 2110 PROSPECT AVE HERMOSA BEACH, CA 90245 | AFLAC | $5 | — | $5 | 0.05% |
| LABAN MATTHEW SPALDING3 Filed as: LABAN SPALDING | 29404 QUAIL RUN DR AGOURA HILLS, CA 91301 | AFLAC | $5 | — | $5 | 0.05% |
| GEOGGREY MALAIS3 | PO BOX 280717 NORTHRIDGE, CA 91328 | AFLAC | $4 | — | $4 | 0.04% |
| JOSEPH A NASCA3 | 28081 W MAPLE AVE BARRINGTON, IL 60010 | AFLAC | $3 | — | $3 | 0.03% |
| OLENA K SHEA3 | 3 MITCHELL PL UNIT 18C NEW YORK, NY 10017 | AFLAC | $2 | — | $2 | 0.02% |
| BRIAN E KATZ3 | 1032 S SIERRA BONITA AVE LOS ANGELES, CA 90019 | AFLAC | $1 | — | $1 | 0.01% |
| ALFRED RIETKERK3 | 438 PISCAH PIKE PULASKI, TN 38478 | 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 | 125 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 127 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HEALTH NET | 181 | $612K |
| Dental(2 contracts, 2 carriers) | HEALTH NET | 181 | $612K |
| Vision(2 contracts, 2 carriers) | HEALTH NET | 181 | $612K |
| Life insurance | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 181 | $159K |
| Other | AFLAC | 4 | $11K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 181 | — |
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.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.