| 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 | CALIFORNIA PHYSICIANS SERVICE | $29K | — | $29K | 2.67% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 9855 SCRANTON ROAD, SUITE 100 SAN DIEGO, CA 92121 | CALIFORNIA PHYSICIANS SERVICE | $28K | — | $28K | 2.58% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 9855 SCRANTON ROAD, SUITE 100 SAN DIEGO, CA 92121 | KAISER FOUNDATION HEALTH PLAN INC. | $12K | $1K | $13K | 1.79% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | KAISER FOUNDATION HEALTH PLAN INC. | $13K | — | $13K | 1.68% |
| LARRY J. BURDT3 | 4275 EXECUTIVE SQUARE, SUITE 400 LA JOLLA, CA 92037 | KAISER FOUNDATION HEALTH PLAN INC. | $6K | — | $6K | 0.87% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | PRINCIPAL LIFE INSURANCE COMPANY | $14K | — | $14K | 5.75% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 9855 SCRANTON ROAD, SUITE 100 SAN DIEGO, CA 92121 | PRINCIPAL LIFE INSURANCE COMPANY | $9K | $4K | $13K | 5.25% |
| LARRY J. BURDT3 | 4275 EXECUTIVE SQUARE, SUITE 400 LA JOLLA, CA 92037 | PRINCIPAL LIFE INSURANCE COMPANY | $5K | — | $5K | 1.94% |
| COLONIAL LIFE & ACCIDENT3 Filed as: COLONIAL - SEE ATTACHMENT | PO BOX 1365 COLUMBIA, SC 29202 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12K | $2K | $14K | 21.91% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | PO BOX 2158 RIVERSIDE, CA 92516 | VISION SERVICE PLAN | $635 | — | $635 | 1.91% |
| LARRY J. BURDT3 Filed as: LARRY BURDT | 4275 EXECUTIVE SQUARE, SUITE 400 LA JOLLA, CA 92037 | VISION SERVICE PLAN | $342 | — | $342 | 1.03% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | VISION SERVICE PLAN | $103 | — | $103 | 0.31% |
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 | 214 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 217 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 147 | $1.8M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 213 | $247K |
| Vision | VISION SERVICE PLAN | 190 | $33K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 213 | $247K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 213 | $247K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 147 | $1.8M |
| Other(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 213 | $313K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 213 | — |
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.