| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 200 WEST CYPRESS CREEK ROAD SUITE 500 FORT LAUDERDALE, FL 33309 | BLUE CROSS OF CALIFORNIA | $124K | $2K | $125K | 5.13% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN INC | $30K | $0 | $30K | 5.00% |
| USI INSURANCE SERVICES LLC3 | 200 SUMMIT LAKE DRIVE, SUITE 350 VALHALLA, NY 10595 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $9K | $0 | $9K | 2.69% |
| JENNIFER MCDONALD3 | 15201 DANA IRVINE, CA 92618 | AFLAC | $2K | $254 | $2K | 6.46% |
| THUY N. PHAM3 Filed as: THUY N. PHAM AND OTHER AGENTS | 600 CALLE BIENVENIDO SAN CLEMENTE, CA 92673 | AFLAC | $2K | $0 | $2K | 4.49% |
| DENISE M. AVILA WALKER3 | 2605 ADELITA DRIVE HACIENDA HEIGHTS, CA 91745 | AFLAC | $812 | $51 | $863 | 2.53% |
| JAIMIE ANNE DUNTON AND OTHER AGENTS3 Filed as: JAIMIE ANNE DUNTON | 25201 PASEO DE ALICIA, UNIT 190 LAGUNA HILLS, CA 92653 | AFLAC | $565 | $0 | $565 | 1.65% |
| STEPHANIE A REYNOSO3 Filed as: STEPHANIE A. REYNOSO | 21 CERVANTES NEWPORT BEACH, CA 92660 | AFLAC | $497 | $51 | $548 | 1.60% |
| EUGENE PEREZ3 Filed as: EUGENE R. PEREZ | 22 RIVERBEND DRIVE PALM COAST, FL 32137 | AFLAC | $492 | $0 | $492 | 1.44% |
| JENNIFER MCDONALD3 | 86 WINDCHIME IRVINE, CA 92603 | AFLAC | $420 | $4 | $424 | 1.24% |
| CHRISTY DAY ASSOCIATES LLC3 Filed as: CHRISTY DAY ASSOCIATES, LLC | 14 WALL STREET, SUITE 8C NEW YORK, NY 10005 | AFLAC | $273 | $21 | $294 | 4.68% |
| HAROLD L LEE & SONS INC3 Filed as: HAROLD LEE AND SONS, INC. | 31 PELL STREET NEW YORK, NY 10013 | AFLAC | $196 | $0 | $196 | 3.12% |
| BRIAN MILLER3 | 14 WALL STREET, 8TH FLOOR NEW YORK, NY 10005 | AFLAC | $147 | $37 | $184 | 2.93% |
| BRIAN MILLER3 Filed as: BRIAN MILLER AND OTHER AGENTS | 52 COURT STREET FREEHOLD, NJ 07728 | AFLAC | $123 | $0 | $123 | 1.96% |
| PATRICK RUHLE3 Filed as: PATRICK C. HARDIE | 14 WALL STREET, SUITE 8C NEW YORK, NY 10005 | AFLAC | $51 | $12 | $63 | 1.00% |
| PATRICK MARK BURNHAM3 | 854 WEST 181ST STREET APARTMENT 4C NEW YORK, NY 10033 | AFLAC | $51 | $7 | $58 | 0.92% |
| TREVOR FENNELL3 | 11835 QUEENS BOULEVARD, SUITE 1403 FOREST HILLS, NY 11375 | AFLAC | $53 | $0 | $53 | 0.84% |
| JESSE RAMOS4 | 7331 SHELBY LANE, SUITE 26 RANCH CUCAMONGA, CA 91739 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $391 | $0 | $391 | 16.77% |
| SHELTER MINISTRIES, INC.4 | 430 COURFIELD DRIVE FRANKLIN, TN 37064 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $31 | $0 | $31 | 1.33% |
| TRACY BROUGHTON4 | 6 EDENDALE STREET LADERA RANCH, CA 92694 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $29 | $0 | $29 | 1.24% |
| USI INSURANCE SERVICES LLC4 | 2375 EAST CAMELBACK ROAD, SUITE 250 PHOENIX, AZ 85016 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $12 | $0 | $12 | 0.51% |
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 | 251 | 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) | 251 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 305 | $3.0M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 251 | $323K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 251 | $323K |
| Life insurance | BLUE CROSS OF CALIFORNIA | 305 | $2.4M |
| Short-term disability(2 contracts) | AFLAC | 41 | $40K |
| Long-term disability | BLUE CROSS OF CALIFORNIA | 305 | $2.4M |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 305 | $3.0M |
| Other(4 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 305 | $2.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 305 | — |
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.