| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 29A TECHNOLOGY DRIVE, SUITE 100 IRVINE, CA 92618 | BLUE CROSS OF CALIFORNIA | $67K | $0 | $67K | 4.96% |
| USI INSURANCE SERVICES LLC3 | PO BOX 3716 NORFOLK, VA 23510 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $5K | $0 | $5K | 3.03% |
| USI INSURANCE SERVICES LLC3 | 200 SUMMIT LAKE DRIVE, SUITE 350 VALHALLA, NY 10595 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $640 | $0 | $640 | 0.36% |
| USI INSURANCE SERVICES LLC3 | 21600 OXNARD STREET, SUITE 830 WOODLAND HILLS, CA 91367 | KAISER FOUNDATION HEALTH PLAN INC | $9K | $0 | $9K | 5.26% |
| USI INSURANCE SERVICES LLC3 | 21600 OXNARD STREET, 8TH FLOOR WOODLAND HILLS, CA 91367 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | $436 | $8K | 11.97% |
| BANKER BENEFITS3 | 1303 J STREET, SUITE 600 SACRAMENTO, CA 95814 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $706 | $0 | $706 | 1.10% |
| EUGENE PEREZ3 Filed as: EUGENE R. PEREZ | 5 GRANDVIEW DRIVE PALM COAST, FL 32137 | AFLAC | $2K | $155 | $3K | 11.50% |
| M H AND ASSOCIATES, INC.3 | 17401 ARMSTRONG AVENUE, SUITE 200 IRVINE, CA 92614 | AFLAC | $547 | $31 | $578 | 2.54% |
| ROBERT BRIAN SHERMAN3 | 24672 LA CRESTA DRIVE, SUITE A DANA POINT, CA 92660 | AFLAC | $545 | $31 | $576 | 2.53% |
| MJ INSURANCE3 Filed as: JOSHUA BALTOR AND VARIOUS AGENTS | 11 AIRPORT BOULEVARD, SUITE 105 SOUTH SAN FRANCISCO, CA 94080 | AFLAC | $540 | $30 | $570 | 2.50% |
| THUY N. PHAM3 | 4000 MACARTHUR BOULEVARD SUITE 550 NEWPORT BEACH, CA 92660 | AFLAC | $256 | $0 | $256 | 1.12% |
| STRATEGIC LIFE INSURANCE3 Filed as: STRATEGIC LIFE INS. SERVICES, INC. | 1936 EAST DEERE AVENUE SANTA ANA, CA 92705 | AFLAC | $166 | $0 | $166 | 0.73% |
| THUY N. PHAM3 | 17401 ARMSTRONG AVENUE, SUITE 200 IRVINE, CA 92614 | AFLAC | $98 | $0 | $98 | 0.43% |
| TRACY BROUGHTON4 | 6 EDENDALE STREET LADERA RANCH, CA 92694 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $50 | $0 | $50 | 4.29% |
| SHELTER MINISTRIES, INC.4 | 31441 SANTA MARGARITA PARKWAY SUITE A244 RANCHO SANTA MARGARITA, CA 92688 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $50 | $0 | $50 | 4.29% |
| MARK MCCORMICK4 Filed as: MARK E. SCHLOM | 10 TAOS RANCHO SANTA MARGARITA, CA 92688 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $29 | $0 | $29 | 2.49% |
| USI INSURANCE SERVICES LLC4 | 29A TECHNOLOGY DRIVE, SUITE 100 IRVINE, CA 92618 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $19 | $0 | $19 | 1.63% |
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. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 211 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 228 | $1.5M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 150 | $179K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 150 | $179K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 211 | $64K |
| Short-term disability | AFLAC | 33 | $23K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 211 | $64K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 228 | $1.5M |
| Other(3 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 211 | $88K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 228 | — |
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.