| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 1950 W CORPORATE WAY #1 ANAHEIM, CA 92801 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 5.52% |
| EMPLOYERS SELECT INSURANCE SERVICES3 Filed as: EMPLOYERS SELECT INS SVCS INC | 5701 LONETREE BLVD STE 305 ROCKLIN, CA 95765 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $963 | — | $963 | 4.48% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 1950 W CORPORATE WAY #1 ANAHEIM, CA 92801 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $585 | — | $585 | 5.75% |
| EMPLOYER SELECT INS SVCS INC3 | 5701 LONETREE BLVD STE 305 ROCKLIN, CA 95765 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $431 | — | $431 | 4.24% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 1950 W CORPORATE WAY #1 ANAHEIM, CA 92801 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $371 | — | $371 | 5.68% |
| EMPLOYERS SELECT INSURANCE SERVICES3 Filed as: EMPLOYERS SELECT INS SVC INC | 5701 LONETREE BLVD STE 305 ROCKLIN, CA 95765 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $283 | — | $283 | 4.33% |
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 | 223 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 223 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 44 | $21K |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 107 | $10K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 223 | $7K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 223 | $7K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 223 | — |
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.