| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3130 S HARBOR BLVD STE 140 SANTA ANA, CA 92704 | KAISER FOUNDATION HEALTH PLAN INC | $78K | — | $78K | 4.96% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3 POLARIS WAY 4TH FL ALISO VIEJO, CA 92656 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $43K | — | $43K | 10.67% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3130 S HARBOR BLVD STE 140 SANTA ANA, CA 92704 | METROPOLITAN LIFE INSURANCE COMPANY | $8K | — | $8K | 8.60% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9655 GRANITE RIDGE DR STE 500 SAN DIEGO, CA 92123 | METROPOLITAN LIFE INSURANCE COMPANY | — | $823 | $823 | 0.93% |
| 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 | 5.05% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 16835 W BERNARDO STE 212 SAN DIEGO, CA 92127 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON | $137 | — | $137 | 0.22% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3 POLARIS WAY 4TH FL ALISO VIEJO, CA 92656 | CIGNA DENTAL HEALTH OF CALIFORNIA, INC. | $4K | — | $4K | 10.90% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3 POLARIS WAY 4TH FL ALISO VIEJO, CA 92656 | CIGNA DENTAL HEATH OF TEXAS, INC. | $278 | — | $278 | 10.89% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3 POLARIS WAY 4TH FL ALISO VIEJO, CA 92656 | CIGNA DENTAL HEALTH OF FLORIDA, INC. | $264 | — | $264 | 10.90% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3 POLARIS WAY 4TH FL ALISO VIEJO, CA 92656 | CIGNA DENTAL HEALTH PLAN OF ARIZONA, INC. | $158 | — | $158 | 10.87% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3 POLARIS WAY 4TH FL ALISO VIEJO, CA 92656 | CIGNA DENTAL HEALTH OF ILLINOIS, INC. | $148 | — | $148 | 10.91% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3 POLARIS WAY 4TH FL ALISO VIEJO, CA 92656 | CIGNA DENTAL HEALTH OF MARYLAND, INC. | $74 | — | $74 | 10.91% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALFORNIA LLC | 3 POLARIS WAY 4TH FL ALISO VIEJO, CA 92656 | CIGNA DENTAL HEALTH OF NORTH CAROLINA, INC. | $70 | — | $70 | 10.84% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3 POLARIS WAY 4TH FL ALISO VIEJO, CA 92656 | CIGNA DENTAL HEALTH OF OHIO, INC | $49 | — | $49 | 10.84% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3 POLARIS WAY 4TH FL ALISO VIEJO, CA 92656 | CIGNA DENTAL HEALTH OF KANSAS, INC. | $42 | — | $42 | 10.82% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3 POLARIS WAY 4TH FL ALISO VIEJO, CA 92656 | CIGNA DENTAL HEALTH OF NEW JERSEY, INC. | $42 | — | $42 | 10.82% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3 POLARIS WAY 4TH FL ALISO VIEJO, CA 92656 | CIGNA DENTAL HEALTH OF PENNSYLVANIA, INC. | $42 | — | $42 | 10.82% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3 POLARIS WAY 4TH FL ALISO VIEJO, CA 92656 | CIGNA DENTAL HEALTH OF NEW MEXICO, INC. | $14 | — | $14 | 10.85% |
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 | 1,055 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,056 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 282 | $1.7M |
| Dental(13 contracts, 13 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 541 | $451K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 1,734 | $89K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 1,734 | $89K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 1,734 | $89K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,734 | — |
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.