| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE SOUTHWEST PARTNERS INSURAN | 611 ANTON BLVD STE 1400 COSTA MESA, CA 92626 | KAISER FOUNDATION HEALTH PLAN INC | $21K | — | $21K | 2.40% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3130 S HARBOR BLVD STE 140 SANTA ANA, CA 92704 | KAISER FOUNDATION HEALTH PLAN INC | $11K | — | $11K | 1.27% |
| ACRISURE LLC3 Filed as: ACRISURE SOUTHWEST PARTNERS INSURAN | 611 ANTON BLVD STE 1400 COSTA MESA, CA 92626 | KAISER FOUNDATION HEALTH PLAN INC | $7K | — | $7K | 1.78% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3130 S HARBOR BLVD STE 140 SANTA ANA, CA 92704 | KAISER FOUNDATION HEALTH PLAN INC | $4K | — | $4K | 0.91% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3 POLARIS WAY, 4TH FLOOR ALISO VIEJO, CA 92656 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $8K | — | $8K | 8.73% |
| ACRISURE LLC3 Filed as: ACRISURE SOUTHWEST PARTNERS INSURAN | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | — | $3K | $3K | 3.20% |
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 | 105 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 106 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | KAISER FOUNDATION HEALTH PLAN INC | 126 | $1.3M |
| Dental | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 106 | $92K |
| Vision | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 106 | $92K |
| Life insurance | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 106 | $92K |
| Other | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 106 | $92K |
| 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."
No prospect flags tripped on this filing.