| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 OTTAWA AVE, SW GRAND RAPIDS, MI 49503 | CALIFORNIA PHYSICIANS' SERVICE | — | $25K | $25K | 3.91% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 | 135 MAIN ST 21ST FLOOR SAN FRANCISCO, CA 94105 | CALIFORNIA PHYSICIANS' SERVICE | — | $6K | $6K | 0.91% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WORD & BROWN INS ADMIN INC | 701 S PARKER ST 8TH FLOOR ORANGE, CA 92868 | CALIFORNIA PHYSICIANS' SERVICE | -$1K | — | -$1K | -0.18% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 OTTAWA AVE, SW GRAND RAPIDS, MI 49503 | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | $1K | — | $1K | 9.12% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 | 135 MAIN ST 21ST FLOOR SAN FRANCISCO, CA 94105 | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | $103 | — | $103 | 0.87% |
| MARIBETH TENNISON3 | 3720 SOUTH SUSAN ST SUITE # 200 SANTA ANA, CA 92704 | SAFEGUARD HEALTH PLANS INC | $716 | — | $716 | 7.79% |
| JAMES P BOADA3 Filed as: JAMES BRAKKE | 28202 CABOT ROAD SUITE 600 LAGUNA NIGUEL, CA 92677 | SAFEGUARD HEALTH PLANS INC | $302 | — | $302 | 3.29% |
| TONI ERICKSON3 | 199 MACARTHUR BLVD PENTHOUSE SUITE IRVINE, CA 92618 | SAFEGUARD HEALTH PLANS INC | $80 | — | $80 | 0.87% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3 POLARIS WAY 4TH FLOOR ALISO VIEJO, CA 92656 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $1K | $173 | $1K | 14.36% |
| ENROLLEASE3 | 660 YORK ST SUITE 102 SAN FRANCISCO, CA 94110 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $255 | — | $255 | 2.78% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 | 3620 BIRCH ST NEWPORT BEACH, CA 92660 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $232 | — | $232 | 2.53% |
| ACRISURE LLC3 Filed as: ASCRISURE OF CALIFORNIA LLC | 3 POLARIS WAY #4 ALISO VIEJO, CA 926565338 | VISION SERVICE PLAN | $586 | — | $586 | 6.62% |
| GROUP BENEFIT SERVICES INC3 Filed as: GROUP BENEFIT LTD | 12006 RIDGEMONT DR URBANDALE, IA 503232317 | VISION SERVICE PLAN | $531 | — | $531 | 6.00% |
| ENROLLEASE3 Filed as: ENROLLEASE, INC DBA EASECENTRAL | 1980 FESTIVAL PLAZA DR STE 810 LAS VEGAS, NV 891352958 | VISION SERVICE PLAN | $75 | — | $75 | 0.85% |
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 | 132 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 132 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA PHYSICIANS' SERVICE | 132 | $642K |
| Dental | SAFEGUARD HEALTH PLANS INC | 55 | $9K |
| Vision | VISION SERVICE PLAN | 65 | $9K |
| Life insurance(2 contracts, 2 carriers) | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | 107 | $21K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 132 | $642K |
| Other(2 contracts, 2 carriers) | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | 107 | $21K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 132 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.