| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3 POLARIS WAY FL 4 ALISO VIEJO, CA 92656 | UNITEDHEALTHCARE INSURANCE COMPANY | $46K | — | $46K | 1.72% |
| HAYS COMPANIES, INC.3 | 80 S. 8TH ST. STE 700 MINNEAPOLIS, MN 55402 | UNITEDHEALTHCARE INSURANCE COMPANY | $27K | — | $27K | 1.02% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA | ACRISURE LLC GRAND RAPIDS, MI 49503 | UNITEDHEALTHCARE INSURANCE COMPANY | — | $8K | $8K | 0.29% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | DBA THE LBL INSURANCE 3130 S HARBOR BLVD, STE 140 SANTA ANA, CA 92704 | PRINCIPAL LIFE INSURANCE COMPANY | $31K | — | $31K | 7.98% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INC. | 80 S. 8TH ST. SUITE 700 MINNEAPOLIS, MN 55402 | PRINCIPAL LIFE INSURANCE COMPANY | $18K | — | $18K | 4.78% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | DBA BENEFITS DONE RIGHT 601 UNIVERSITY AVE STE 250 SACRAMENTO, CA 95825 | PRINCIPAL LIFE INSURANCE COMPANY | — | $6K | $6K | 1.61% |
| ACRISURE LLC3 | PO BOX 1788 910 E HAMILTON AVE, STE 410 GRAND RAPIDS, MI 49501 | PRINCIPAL LIFE INSURANCE COMPANY | — | $5K | $5K | 1.35% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3130 S HARBOR BLVD STE 140 SANTA ANA, CA 92704 | KAISER FOUNDATION HEALTH PLAN INC | $2K | — | $2K | 2.29% |
| HAYS COMPANIES, INC.3 | 80 S. 8TH ST. STE 700 MINNEAPOLIS, MN 55402 | KAISER FOUNDATION HEALTH PLAN INC | $2K | — | $2K | 1.67% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3130 S HARBOR BLVD STE 140 SANTA ANA, CA 92704 | KAISER FOUNDATION HEALTH PLAN INC | $978 | — | $978 | 2.31% |
| HAYS COMPANIES, INC.3 | 80 S 8TH ST STE 700 MINNEAPOLIS, MN 55402 | KAISER FOUNDATION HEALTH PLAN INC | $715 | — | $715 | 1.69% |
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 | 294 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 300 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 442 | $2.8M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 294 | $384K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 294 | $384K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 294 | $384K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 294 | $384K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 294 | $384K |
| Other | PRINCIPAL LIFE INSURANCE COMPANY | 294 | $384K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 442 | — |
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."
No prospect flags tripped on this filing.