| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 100 OTTAWA AVENUE SW GRAND RAPIDS, MI 49503 | HEALTHNET | $50K | $0 | $50K | 5.48% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 18952 MACARTHUR BOULEVARD IRVINE, CA 92612 | AMERITAS LIFE INSURANCE CORPORATION | $9K | $0 | $9K | 10.00% |
| AMWINS3 Filed as: AMWINS CONNECT INS. SERVICES, INC. | 2677 NORTH MAIN STREET, SUITE 800 SANTA ANA, CA 92705 | AMERITAS LIFE INSURANCE CORPORATION | $3K | $0 | $3K | 3.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 8659 RESEARCH DRIVE IRVINE, CA 92618 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $0 | $1K | 10.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 100 SPECTRUM CENTER DRIVE SUITE 400 IRVINE, CA 92618 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $141 | $141 | 1.15% |
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 | 102 | 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) | 102 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTHNET | 124 | $914K |
| Dental | AMERITAS LIFE INSURANCE CORPORATION | 255 | $90K |
| Vision | AMERITAS LIFE INSURANCE CORPORATION | 255 | $90K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 39 | $12K |
| Prescription drug | HEALTHNET | 124 | $914K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 39 | $12K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 255 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.