| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | KAISER FOUNDATION HEALTH PLAN INC | $17K | — | $17K | 5.02% |
| AMWINS3 Filed as: AMWINS CONNECT INS SVCS, LLC | 2677 N MAIN STREET. SUITE 800 SANTA ANA, CA 92705 | KAISER FOUNDATION HEALTH PLAN INC | $7K | — | $7K | 2.06% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | PRINCIPAL LIFE INSURANCE COMPANY | $12K | — | $12K | 14.87% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INS SVCS INC | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | $792 | $3K | 3.93% |
| STAN BURNS INSURANCE SVCS INC3 | PO BOX 3309 TORRANCE, CA 90510 | PRINCIPAL LIFE INSURANCE COMPANY | $34 | — | $34 | 0.04% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | BLUE CROSS OF CALIFORNIA | $24K | — | $24K | 48.28% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS AND FINANCIAL SVCS | 12404 PARK CENTRAL DR, STE 400S DALLAS, TX 75251 | BLUE CROSS OF CALIFORNIA | — | $12K | $12K | 24.14% |
| COLONIAL LIFE & ACCIDENT3 Filed as: COLONIAL - SEE ATTACHMENT | PO BOX 1365 COLUMBIA, SC 29202 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $192 | $3K | 28.73% |
| VARIOUS - SEE ATTACHED3 Filed as: AFLAC - SEE ATTACHMENT | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $361 | — | $361 | 10.38% |
| EVAN PENNET4 | 13725 CUMPSTON STREET SHERMAN OAKS, CA 91401 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $695 | — | $695 | 23.79% |
| MICHELLE A BABITZ3 | 28505 TAOS COURT CATHEDRAL CITY, CA 92234 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $149 | — | $149 | 5.10% |
| JOAN WILLIAMS4 | 12721 GARDEN GORVE BLVD #302 GARDEN GROVE, CA 92843 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $24 | — | $24 | 0.82% |
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 | 126 | 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) | 127 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 51 | $379K |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 126 | $83K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 126 | $83K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 126 | $83K |
| Short-term disability(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 9 | $15K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 51 | $379K |
| Other(4 contracts, 4 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 126 | $101K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 126 | — |
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."
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.