| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 500 N SANTA FE VISALIA, CA 93292 | CALIFORNIA PHYSICIANS SERVICE | $260 | $75K | $75K | 2.15% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | CALIFORNIA PHYSICIANS SERVICE | $78 | $36K | $36K | 1.03% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 18201 VON KARMAN AVENUE, SUITE 200 IRVINE, CA 92612 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $19K | — | $19K | 5.30% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $10K | — | $10K | 2.64% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 18201 VON KARMAN AVENUE, SUITE 200 IRVINE, CA 92612 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | $561 | $6K | 8.30% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 2.50% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | TWO PIERCE PLACE, 21ST FL ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 5.11% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 2850 W GOLF ROAD, 11TH FL ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $75 | $75 | 0.25% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $56 | — | $56 | 0.19% |
| SYNERGY ENROLLMENT AND BENEFITS LLC3 | 9370 SKY PARK COURT, SUITE 250 SAN DIEGO, CA 92123 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8 | — | $8 | 0.03% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | VISION SERVICE PLAN | $481 | — | $481 | 1.68% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | TWO PIERCE PLACE, 21ST FL ITASCA, IL 60143 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $532 | — | $532 | 3.57% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 2850 W GOLF ROAD, 11TH FL ROLLING MEADOWS, IL 60008 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $23 | $23 | 0.15% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 18201 VON KARMAN AVENUE, SUITE 200 IRVINE, CA 92614 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $768 | $102 | $870 | 8.49% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $256 | — | $256 | 2.50% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | MAGELLAN HEALTH SERVICES | $993 | — | $993 | 10.00% |
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 | 402 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 403 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA PHYSICIANS SERVICE | 294 | $3.5M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 295 | $365K |
| Vision | VISION SERVICE PLAN | 244 | $29K |
| Life insurance(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 395 | $69K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 208 | $10K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 352 | $71K |
| Prescription drug | CALIFORNIA PHYSICIANS SERVICE | 294 | $3.5M |
| Other(3 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 395 | $94K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 395 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.