| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE WEST COAST INSURANCE SVCS | LLC 5664 PRAIRE CREEK DR CALEDONIA, MI 49316 | BLUE SHIELD OF CALIFORNIA | $87K | $54 | $87K | 5.14% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LL | 28202 CABOT RD STE 600 LAGUNA NIGUEL, CA 92677 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 10.00% |
| BETTY MURDOCK3 | 7216 TESSERA PKWY LAGO VISTA, TX 78645 | AFLAC | $1K | $10 | $1K | 5.88% |
| ACEVES INSURANCE SERVICES INC.3 Filed as: ACEVES INSURANCE SERVICES INC | 9959 BROOKSHIRE AVE DOWNEY, CA 90240 | AFLAC | $262 | — | $262 | 1.28% |
| KATHLEEN S HANSON3 Filed as: KATHLEEN HANSON | 2581 HILLCREST ST SIGNAL HILL, CA 90755 | AFLAC | $184 | — | $184 | 0.90% |
| KENNETH J WOOD3 | 10224 MANORVILLE DR JACKSONVILLE, FL 32221 | AFLAC | $176 | — | $176 | 0.86% |
| CLAY W CAMPBELL3 Filed as: CLAY CAMPBELL | 14720 LIBLEN AVE BELLFLOWER, CA 90706 | AFLAC | $99 | — | $99 | 0.48% |
| ANDREA M MACIAS3 Filed as: ANDREA MACIAS | 7216 TESSERA PKWY LAGO VISTA, TX 78645 | AFLAC | $98 | — | $98 | 0.48% |
| CHRIS GUZEWICH3 | 1007 DRAKE FEATHER DR ORANGE PARK, FL 32065 | AFLAC | $72 | — | $72 | 0.35% |
| RENE CASTRO3 | 2581 HILLCREST ST SIGNAL HILL, CA 90755 | AFLAC | $66 | — | $66 | 0.32% |
| JUANITA BURKS & ASSOCIATES3 | 6100 CENTER DR STE 670 LOS ANGELES, CA 90045 | AFLAC | $56 | $2 | $58 | 0.28% |
| H THOMSON3 | 65 PINE AVE 102 LONG BEACH, CA 90802 | AFLAC | $39 | — | $39 | 0.19% |
| THOMAS JAMES OLLER3 Filed as: THOMAS OLLER | 49 SWIMMING PEN DR MIDDLEBURG, FL 32068 | AFLAC | $38 | — | $38 | 0.19% |
| TODD V MASON3 Filed as: TODD MASON | 6164 LAWRENCE ST CYPRESS, CA 90630 | AFLAC | $32 | — | $32 | 0.16% |
| KAREN M HUGHES3 Filed as: KAREN HUGHES | 3120 NE 47TH ST FORT LAUDERDALE, FL 33308 | AFLAC | $30 | — | $30 | 0.15% |
| CHRISTOPHER HAGER3 | 8201 PARK HILL DR LOS ANGELES, CA 90045 | AFLAC | $27 | $2 | $29 | 0.14% |
| FRAN C HARGARTEN III3 Filed as: FRAN HARGARTEN III | 1140 MOSSY ROCK RD NW KENNESAW, GA 30152 | AFLAC | $27 | — | $27 | 0.13% |
| TROY DANIEL DESLATTE3 Filed as: TROY DESLATTE | 107 SHADY PARK DR LAFAYETTE, LA 70508 | AFLAC | $26 | — | $26 | 0.13% |
| TIANI C. WARREN3 Filed as: TIANI WARREN | 5700 COLISEUM ST LOS ANGELES, CA 90016 | AFLAC | $16 | — | $16 | 0.08% |
| THELMA ZAMBRANO3 | 8504 FIRESTONE BLVD 276 DOWNEY, CA 90241 | AFLAC | $16 | — | $16 | 0.08% |
| GEOFFREY MALAIS3 | 16800 DEVONSHIRE ST STE 220 GRANADA HILLS, CA 91344 | AFLAC | $9 | — | $9 | 0.04% |
| JAY WILLIAMS3 | 3464 HATHAWAY AVE APT 335 LONG BEACH, CA 90815 | AFLAC | $6 | — | $6 | 0.03% |
| ADAM H MICHAELS3 Filed as: ADAM MICHAELS | 12121 WILSHIRE BLVD STE 1225 LOS ANGELES, CA 90025 | AFLAC | $5 | — | $5 | 0.02% |
| BRANDON ADAMS3 | 74 CROWN COLONY RD SAINT AUGUSTINE, FL 32092 | AFLAC | $5 | — | $5 | 0.02% |
| J C ADAMS INC3 | 5631 NE 31ST TER OCALA, FL 34479 | AFLAC | $4 | — | $4 | 0.02% |
| JOANNA G MATHERLY3 Filed as: JOANNA MATHERLY | 2000 GLEN ECHO RD STE 204 NASHVILLE, TN 37215 | AFLAC | $3 | — | $3 | 0.01% |
| ALFRED RIETKERK3 | 3120 NE 47TH ST FT LAUDERDALE, FL 33308 | AFLAC | $2 | — | $2 | 0.01% |
| SETH JAFFE3 | 4127 E. MASSACHUSETTS ST. LONG BEACH, CA 90814 | AFLAC | $1 | — | $1 | 0.00% |
| HENRY SAUCEDA3 | 2268 ALPHA CIR LA VERNE, CA 91750 | AFLAC | $1 | — | $1 | 0.00% |
| JIMMY LEON JOHNSON3 Filed as: JIMMY JOHNSON | 28 MAGNOLIA AVE ST AUGUSTINE, FL 32084 | AFLAC | $1 | — | $1 | 0.00% |
| JEFFREY M SINTAY3 Filed as: JEFFREY SINTAY | 1972 ALCOVA RIDGE DR LAS VEGAS, NV 89135 | AFLAC | $1 | — | $1 | 0.00% |
| JOSEPH A BUZZELLO3 Filed as: JOSEPH BUZZELLO | 9018 BALBOA BLVD STE 254 NORTHRIDGE, CA 91325 | AFLAC | $1 | — | $1 | 0.00% |
| ACRISURE LLC3 Filed as: ACRISURE WEST COAST INSURANCE SVCS | LLC 5664 PRAIRE CREEK DR CALEDONIA, MI 49316 | BLUE SHIELD OF CALIFORNIA LIFE & HEALTH INSURANCE COMPANY | $431 | — | $431 | 5.01% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LL | 28202 CABOT RD STE 600 LAGUNA NIGUEL, CA 92677 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $168 | — | $168 | 10.02% |
| E LEE & ASSOCIATES INC.3 Filed as: E LEE & ASSOCIATES INC | 16835 W BERNARDO DR, #212 SAN DIEGO, CA 92127 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $9K | — | $9K | — |
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 | 214 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 215 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE SHIELD OF CALIFORNIA | 372 | $1.7M |
| Dental(2 contracts, 2 carriers) | BLUE SHIELD OF CALIFORNIA | 372 | $1.7M |
| Vision(2 contracts, 2 carriers) | BLUE SHIELD OF CALIFORNIA | 372 | $1.7M |
| Life insurance(2 contracts, 2 carriers) | BLUE SHIELD OF CALIFORNIA LIFE & HEALTH INSURANCE COMPANY | 204 | $9K |
| Long-term disability(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 203 | $26K |
| Prescription drug | BLUE SHIELD OF CALIFORNIA | 372 | $1.7M |
| Other(3 contracts, 3 carriers) | AFLAC | 204 | $31K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 372 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.