| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | PO BOX 1788 GRAND RAPIDS, MI 49501 | UNITEDHEALTHCARE INSURANCE COMPANY | $73K | — | $73K | 4.63% |
| ROGERS BENEFIT GROUP INC3 Filed as: ROGERS BENEFITS GROUP INC-CA | 2251 DOUGLAS BLVD STE 115 ROSEVILLE, CA 95661 | UNITEDHEALTHCARE INSURANCE COMPANY | $13K | — | $13K | 0.85% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA | 9655 GRANITE RIDGE DR STE 500 SAN DIEGO, CA 92123 | UNITEDHEALTHCARE INSURANCE COMPANY | — | $12K | $12K | 0.75% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9655 GRANITE RIDGE DR #500 SAN DIEGO, CA 92123 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $24K | — | $24K | 16.25% |
| BURNHAM BENEFITS INSURANCE SERVICES3 Filed as: BURNHAM BENEFITS INS | 2211 MICHELSON DR SUITE 1200 IRVINE, CA 92612 | LIFE INSURANCE COMPANY OF NORTH AMERICA | -$2K | — | -$2K | -1.25% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9655 GRANITE RIDGE DR STE 500 SAN DIEGO, CA 92123 | METROPOLITAN LIFE INSURANCE COMPANY | $13K | $2K | $15K | 11.94% |
| ROGERS BENEFIT GROUP INC3 Filed as: ROGERS BENEFIT GRP INC | 5110 N 40TH ST STE 234 PHOENIX, AZ 85018 | METROPOLITAN LIFE INSURANCE COMPANY | $6K | — | $6K | 5.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9655 GRANITE RIDGE DR #500 SAN DIEGO, CA 92123 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $11K | — | $11K | 16.23% |
| BURNHAM BENEFITS INSURANCE SERVICES3 Filed as: BURNHAM BENEFITS INSURANCE | 2211 MICHELSON DR SUITE 1200 IRVINE, CA 92612 | LIFE INSURANCE COMPANY OF NORTH AMERICA | -$807 | — | -$807 | -1.23% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9655 GRANITE RIDGE DR #500 SAN DIEGO, CA 92123 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 16.50% |
| BURNHAM BENEFITS INSURANCE SERVICES3 Filed as: BURNHAM BENEFITS INS | 2211 MICHELSON DR SUITE 1200 IRVINE, CA 92612 | LIFE INSURANCE COMPANY OF NORTH AMERICA | -$297 | — | -$297 | -1.50% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9655 GRANITE RIDGE DR #500 SAN DIEGO, CA 92123 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 16.06% |
| BURNHAM BENEFITS INSURANCE SERVICES3 Filed as: BURNHAM BENEFITS INS | 2211 MICHELSON DR SUITE 1200 IRVINE, CA 92612 | LIFE INSURANCE COMPANY OF NORTH AMERICA | -$108 | — | -$108 | -1.06% |
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 | 165 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 170 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 237 | $1.6M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 359 | $129K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 359 | $129K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 174 | $146K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 174 | $20K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 174 | $66K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 174 | $10K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 359 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
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.