| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | PO BOX 1788 GRAND RAPIDS, MI 49501 | UNITEDHEATHCARE INSURANCE COMPANY | $36K | $0 | $36K | 4.31% |
| BENNIE INSURANCE, LLC3 | 700 CANAL STREET, SUITE 1 STAMFORD, CT 06902 | UNITEDHEATHCARE INSURANCE COMPANY | $18K | $0 | $18K | 2.13% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | PO BOX 7746 CITRUS HEIGHTS, CA 95621 | KAISER FOUNDATION HEALTH PLAN, INC. | $7K | $0 | $7K | 3.25% |
| BENNIE INSURANCE, LLC3 | 700 CANAL STREET, SUITE 1 STAMFORD, CT 06902 | KAISER FOUNDATION HEALTH PLAN, INC. | $4K | $0 | $4K | 1.63% |
| ROGERS BENEFIT GROUP INC3 Filed as: ROGERS BENEFIT GROUP, INC. | 5110 NORTH 40TH STREET, SUITE 234 PHOENIX, AZ 85018 | KAISER FOUNDATION HEALTH PLAN, INC. | $1K | $0 | $1K | 0.57% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE, LLC | 200 GALLERIA PARKWAY SE, SUITE 1950 ATLANTA, GA 30339 | KAISER FOUNDATION HEALTH PLAN, INC. | -$78 | $0 | -$78 | -0.04% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | PO BOX 1788 GRAND RAPIDS, MI 49501 | PRINCIPAL LIFE INSURANCE COMPANY | $3K | $0 | $3K | 3.66% |
| CENTRO BENEFITS RESEARCH LLC3 Filed as: CENTRO BENEFITS RESEARCH, LLC | 200 GALLERIA PARKWAY SE, SUITE 1950 ATLANTA, GA 30339 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $3K | $3K | 3.19% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 601 UNIVERSITY AVENUE, SUITE 250 SACRAMENTO, CA 95825 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $1K | $1K | 1.59% |
| BENNIE INSURANCE, LLC3 | 700 CANAL STREET, SUITE 1 STAMFORD, CT 06902 | PRINCIPAL LIFE INSURANCE COMPANY | $1K | $0 | $1K | 1.24% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 208 SOUTH LA SALLE STREET SUITE 1560 CHICAGO, IL 60604 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $403 | $403 | 0.48% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $224 | $224 | 0.26% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE, LLC | 200 GALLERIA PARKWAY SE, SUITE 1950 ATLANTA, GA 30339 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $216 | $216 | 0.26% |
| BENNIE INSURANCE, LLC3 | 700 CANAL STREET, SUITE 1 STAMFORD, CT 06902 | CALIFORNIA DENTAL NETWORK | $306 | $0 | $306 | 6.64% |
| RYAN BEDROSIAN3 | 224 11TH STREET SAN FRANCISCO, CA 94103 | CALIFORNIA DENTAL NETWORK | $141 | $0 | $141 | 3.06% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | PO BOX 1788 GRAND RAPIDS, MI 49501 | CALIFORNIA DENTAL NETWORK | $14 | $0 | $14 | 0.30% |
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 | 172 | 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) | 172 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNITEDHEATHCARE INSURANCE COMPANY | 171 | $1.1M |
| Dental(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 172 | $89K |
| Vision(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 172 | $85K |
| Life insurance | UNITEDHEATHCARE INSURANCE COMPANY | 171 | $835K |
| Short-term disability | UNITEDHEATHCARE INSURANCE COMPANY | 171 | $835K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN, INC. | 32 | $219K |
| Other(2 contracts, 2 carriers) | UNITEDHEATHCARE INSURANCE COMPANY | 172 | $919K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 172 | — |
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.