| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE SOUTHWEST PARTNERS INSURAN | 4000 WESTERLY PL STE 110 NEWPORT BEACH, CA 92660 | KAISER FOUNDATION HEALTH PLAN, INC. | $14K | — | $14K | 2.68% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3130 S HARBOR BLVD STE 140 SANTA ANA, CA 92704 | KAISER FOUNDATION HEALTH PLAN, INC. | $11K | $2K | $14K | 2.62% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 2677 N MAIN ST STE 800 SANTA ANA, CA 92705 | KAISER FOUNDATION HEALTH PLAN, INC. | $6K | — | $6K | 1.11% |
| DAVID O CHRISTENSEN3 | 396 CYPRESS DR APT F LAGUNA BEACH, CA 92651 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6K | $5K | $11K | 7.01% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 4000 WESTERLY PLACE NEWPORT BEACH, CA 92660 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10K | — | $10K | 6.74% |
| ENROLL TECH INC3 | 396 CYPRESS DR APT F LAGUNA BEACH, CA 92651 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6K | $4K | $10K | 6.62% |
| MICHAEL F FAHEY III3 | 103 PALM DR SAN CLEMENTE, CA 92672 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $2K | $6K | 3.68% |
| LUIS ERNESTO PEREZ3 Filed as: LUIS PEREZ BENEFIT INSURANCE SOLUTI | 861 KENWOOD ST UPLAND, CA 91784 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $754 | $4K | 2.49% |
| RAYMOND KWOCKMAN GONG3 | 1907 COLUMBIA ST APT 501 SAN DIEGO, CA 92101 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $632 | $4K | 2.40% |
| JB CREATIVE SOLUTIONS LLC3 | 3881 FREEMAN WAY PROSPER, TX 75078 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $41 | $3K | 1.70% |
| LUZ CASTILLO BARRIGA3 | 22019 JUAN AVE HAWAIIAN GARDENS, CA 90716 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $167 | $2K | 1.32% |
| CONTRACTING PARTNERS LLC3 | PO BOX 646 ROSEVILLE, CA 95678 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 1.23% |
| MARIA YVONNE RODIGHIERO3 | 28502 SHRIKE DR LAGUNA NIGUEL, CA 92677 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $198 | $2K | 1.12% |
| RUBEN RODRIGUEZ BAEZA3 | 10760 DROXFORD ST UNIT 3 CERRITOS, CA 90703 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $3 | $2K | 1.04% |
| LUIS RAFAEL VALLE3 | 2354 CHATKA LN SAN BERNARDINO, CA 92410 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $726 | $34 | $760 | 0.49% |
| ERIC ALEXANDER NOVOA3 | 17871 SHADY VIEW DR UNIT 1503 CHINO HILLS, CA 91709 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $128 | $13 | $141 | 0.09% |
| ALENDY G AGUILAR3 | 12972 SUSANVILLE ST HESPERIA, CA 92344 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $130 | — | $130 | 0.08% |
| MARGARITA ALEJANDRA RAMIREZ3 | 1356 CALLE COLNETT SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $69 | — | $69 | 0.04% |
| GOLD RIVER FINANCIAL GROUP LLC3 | 2807 GRATTON ST RIVERSIDE, CA 92504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $42 | $1 | $43 | 0.03% |
| MARIA C GONZALEZ3 | 11677 SANDPIPER CT MORENO VALLEY, CA 92557 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $34 | — | $34 | 0.02% |
| ROSE VILLALON PASQUEL3 | 552 E CARSON ST # 104-412 CARSON, CA 90745 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA,LLC | 100 OTTAWA AVE. SW GRAND RAPIDS, MI 49503 | HEALTH NET | $5K | — | $5K | 5.99% |
| ACRISURE LLC3 Filed as: ACRISURE SOUTHWEST PARTNERS | INSURANCE SERVICES, LLC 611 ANTON BLVD STE 1400 COSTA MESA, CA 92626 | PRINCIPAL LIFE INSURANCE COMPANY | $6K | $1K | $7K | 12.57% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | PO BOX 1788 GRAND RAPIDS, MI 49501 | PRINCIPAL LIFE INSURANCE COMPANY | — | $1K | $1K | 1.95% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WORD AND BROWN BENEFIT ADMIN | 721 S PARKER ST STE 300 ORANGE, CA 92868 | PRINCIPAL LIFE INSURANCE COMPANY | — | $556 | $556 | 0.97% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3 POLARIS WAY, 4TH FLOOR ALISO VIEJO, CA 92656 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $840 | $600 | $1K | 17.14% |
| ACRISURE LLC3 Filed as: ACRISURE SOUTHWEST PARTNERS INSURAN | 4000 WESTERLY PL STE 110 NEWPORT BEACH, CA 92660 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | — | $600 | $600 | 7.14% |
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 | 166 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 166 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 67 | $598K |
| Dental(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 187 | $66K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 187 | $57K |
| Life insurance(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 187 | $212K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 95 | $154K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 187 | — |
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.