| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 1120 BRISTOL STREET COSTA MESA, CA 92626 | KAISER FOUNDATION HEALTH PLAN INC | $27K | $0 | $27K | 6.24% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 3 POLARIS WAY, 4TH FLOOR ALISO VIEJO, CA 92656 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $7K | $0 | $7K | 10.00% |
| ENROLLEASE3 | 660 YORK STREET, SUITE 102 SAN FRANCISCO, CA 94110 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $1K | $0 | $1K | 2.05% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 1120 BRISTOL STREET COSTA MESA, CA 92626 | KAISER FOUNDATION HEALTH PLAN INC | $4K | $0 | $4K | 6.62% |
| DAVID O CHRISTENSEN3 Filed as: DAVID CHRISTENSEN | 180 MCKNIGHT DRIVE LAGUNA BEACH, CA 92651 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8K | $7K | $15K | 31.16% |
| MICHAEL F FAHEY III3 Filed as: MICHAEL FAHEY III | 103 PALM DRIVE SAN CLEMENTE, CA 92672 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $3K | $6K | 12.48% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 1120 BRISTOL STREET COSTA MESA, CA 92626 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $561 | $5K | 10.09% |
| EDITH VIEYRA3 | 1432 EAST MARKET STREET LONG BEACH, CA 90805 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $0 | $4K | 8.43% |
| ELIZABETH CELIS3 | 2442 PALM PLACE HUNTINGTON PARK, CA 90255 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $0 | $2K | 4.19% |
| MARGARITA ALEJANDRA RAMIREZ3 Filed as: MARGARITA RAMIREZ AND OTHER AGENTS | 1356 CALLE COLNETT SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $790 | $564 | $1K | 2.78% |
| LUIS RAFAEL VALLE3 | 2354 CHATKA LANE SAN BERNADINO, CA 92410 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $380 | $53 | $433 | 0.89% |
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 | 143 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 143 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | KAISER FOUNDATION HEALTH PLAN INC | 100 | $496K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 143 | $69K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 143 | $69K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 143 | $69K |
| Prescription drug(2 contracts) | KAISER FOUNDATION HEALTH PLAN INC | 100 | $496K |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 143 | $117K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 143 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.