| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 OTTAWA AVE. GRAND RAPIDS, MI 49503 | AETNA LIFE INSURANCE COMPANY | $265K | $12K | $277K | 5.60% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | KAISER FOUNDATION HEALTH PLAN INC. | $17K | — | $17K | 3.33% |
| BENEFITS AMERICA INSURANCE SERVICES3 | 1800 QUAIL STREET, SUITE 110 NEWPORT BEACH, CA 92660 | KAISER FOUNDATION HEALTH PLAN INC. | $6K | — | $6K | 1.25% |
| VENGROOK INSURANCE SERVICES3 | 6320 CANOGA AVENUE, 12TH FLOOR WOODLAND HILLS, CA 91367 | KAISER FOUNDATION HEALTH PLAN INC. | $2K | — | $2K | 0.41% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | METROPOLITAN LIFE INSURANCE COMPANY | $136K | $6K | $142K | 32.25% |
| DANIEL MACLELLAN3 | P.O. BOX 58434 NASHVILLE, TN 37205 | METROPOLITAN LIFE INSURANCE COMPANY | $20K | — | $20K | 4.60% |
| PLANSOURCE BENEFITS ADMINISTRATION3 Filed as: PLANSOURCE BENEFITS | 101 S GARLAND AVE. ORLANDO, FL 32801 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | — | $5K | 1.20% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | KAISER FOUNDATION HEALTH PLAN INC. | $5K | — | $5K | 3.31% |
| BENEFITS AMERICA INSURANCE SERVICES3 | 1800 QUAIL STREET, SUITE 110 NEWPORT BEACH, CA 92660 | KAISER FOUNDATION HEALTH PLAN INC. | $2K | — | $2K | 1.23% |
| VENGROOK INSURANCE SERVICES3 | 6320 CANOGA AVENUE, 12TH FLOOR WOODLAND HILLS, CA 91367 | KAISER FOUNDATION HEALTH PLAN INC. | $696 | — | $696 | 0.43% |
| DANIEL MACLELLAN3 | P.O. BOX 58434 NASHVILLE, TN 37205 | METROPOLITAN LIFE INSURANCE COMPANY | $8K | — | $8K | 9.77% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | METROPOLITAN LIFE INSURANCE COMPANY | $6K | $400 | $7K | 7.94% |
| PLANSOURCE BENEFITS ADMINISTRATION3 Filed as: PLANSOURCE BENEFITS | 101 S GARLAND AVE. ORLANDO, FL 32801 | METROPOLITAN LIFE INSURANCE COMPANY | $496 | — | $496 | 0.61% |
| DANIEL MACLELLAN3 | P.O. BOX 58434 NASHVILLE, TN 37205 | METROPOLITAN LIFE INSURANCE COMPANY | $7K | — | $7K | 11.71% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | $153 | $2K | 3.33% |
| PLANSOURCE BENEFITS ADMINISTRATION3 Filed as: PLANSOURCE BENEFITS | 101 S GARLAND AVE. ORLANDO, FL 32801 | METROPOLITAN LIFE INSURANCE COMPANY | $417 | — | $417 | 0.68% |
| DANIEL MACLELLAN3 | P.O. BOX 58434 NASHVILLE, TN 37205 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | — | $4K | 9.76% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | $207 | $3K | 7.91% |
| PLANSOURCE BENEFITS ADMINISTRATION3 Filed as: PLANSOURCE BENEFITS | 101 S GARLAND AVE. ORLANDO, FL 32801 | METROPOLITAN LIFE INSURANCE COMPANY | $257 | — | $257 | 0.63% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | SAFEGUARD HEALTH PLANS, INC. | — | $197 | $197 | 9.65% |
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 | 636 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 638 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(6 contracts, 3 carriers) | AETNA LIFE INSURANCE COMPANY | 748 | $5.8M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 1,175 | $443K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 1,175 | $441K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 1,175 | $441K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 1,175 | $441K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 1,175 | $441K |
| Prescription drug(3 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 748 | $5.6M |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 1,175 | $441K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,175 | — |
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.