| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | BLUE CROSS OF CALIFORNIA | $187K | $12K | $200K | 5.93% |
| USI INSURANCE SERVICES LLC3 | 6100 FAIRVIEW ROAD, SUITE 1400 CHARLOTTE, NC 28210 | BLUE CROSS OF CALIFORNIA | $0 | $4K | $4K | 0.12% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN INC | $36K | $124 | $37K | 4.59% |
| NAZMI J. GJONBALAJ3 Filed as: NAZMI GJONBALAJ AND OTHER AGENTS | 24332 ANDREA STREET LAGUNA HILLS, CA 92656 | AFLAC | $817 | $0 | $817 | 2.61% |
| DENISE M. AVILA WALKER3 Filed as: DENISE AVILA WALKER | 2605 ADELITA DRIVE HACIENDA HEIGHTS, CA 91745 | AFLAC | $769 | $38 | $807 | 2.58% |
| JENNIFER MCDONALD3 | 15201 DANA IRVINE, CA 92618 | AFLAC | $435 | $0 | $435 | 1.39% |
| EUGENE PEREZ3 | 22 RIVERBEND DRIVE PALM COAST, FL 32137 | AFLAC | $419 | $0 | $419 | 1.34% |
| THUY N. PHAM3 Filed as: THUY PHAM | 600 CALLE BIENVENIDO SAN CLEMENTE, CA 92673 | AFLAC | $324 | $0 | $324 | 1.04% |
| STEPHANIE A REYNOSO3 Filed as: STEPHANIE REYNOSO | 21 CERVANTES NEWPORT BEACH, CA 92660 | AFLAC | $265 | $9 | $274 | 0.88% |
| MIRIAM HUNGERFORD3 | 33622 HOLTZ HILL ROAD DANA POINT, CA 92629 | AFLAC | $227 | $0 | $227 | 0.73% |
| CHRISTY DAY3 | 199 WATER STREET, 23RD FLOOR NEW YORK, NY 10038 | AFLAC | $147 | $0 | $147 | 3.23% |
| DENISE M. AVILA WALKER3 Filed as: DENISE AVILA-WALKER | 2605 ADELITA DRIVE HACIENDA HEIGHTS, CA 91745 | AFLAC | $96 | $14 | $110 | 2.42% |
| BRIAN MILLER3 | 52 COURT STREET FREEHOLD, NJ 07728 | AFLAC | $62 | $0 | $62 | 1.36% |
| TREVOR FENNELL3 | 7 HIGHLAND LANE EAST HAMPTON, NY 11937 | AFLAC | $42 | $0 | $42 | 0.92% |
| PATRICK RUHLE3 Filed as: PATRICK HARDIE AND OTHER AGENTS | 14 WALL STREET, SUITE 8C NEW YORK, NY 10005 | AFLAC | $37 | $0 | $37 | 0.81% |
| KENNETH C MEIER CORP3 Filed as: KENNETH C. MEIER CORPORATION | 19 MARKWOOD ROAD GARDEN CITY, NY 11530 | AFLAC | $24 | $0 | $24 | 0.53% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: KEVIN GALLAGHER | 2640 LAKE SHORE DRIVE, UNIT 411 RIVIERA BEACH, FL 33404 | AFLAC | $20 | $0 | $20 | 0.44% |
| JESSE RAMOS4 | 7331 SHELBY PLACE, APARTMENT 26 RANCHO CUCAMONGA, CA 91739 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $264 | $0 | $264 | 8.51% |
| BY HIS DESIGN, INC.4 | 430 COURFIELD DRIVE FRANKLIN, TN 37064 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $33 | $0 | $33 | 1.06% |
| TRACY BROUGHTON4 | 6 EDENDALE STREET LADERA RANCH, CA 92694 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $21 | $0 | $21 | 0.68% |
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 | 270 | 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) | 270 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 431 | $4.2M |
| Dental | BLUE CROSS OF CALIFORNIA | 431 | $3.4M |
| Vision | BLUE CROSS OF CALIFORNIA | 431 | $3.4M |
| Life insurance | BLUE CROSS OF CALIFORNIA | 431 | $3.4M |
| Short-term disability(2 contracts) | AFLAC | 30 | $36K |
| Long-term disability | BLUE CROSS OF CALIFORNIA | 431 | $3.4M |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 431 | $4.2M |
| Other(4 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 431 | $3.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 431 | — |
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.