| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | BLUE CROSS OF CALIFORNIA | $83K | $61K | $144K | 4.41% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | KAISER FOUNDATION HEALTH PLAN INC | $43K | — | $43K | 2.48% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $37K | $27K | $64K | 4.41% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | BLUE CROSS OF CALIFORNIA | $48K | — | $48K | 5.26% |
| CAREMASTER INSURANCE AGENCY INC3 | 12474 RIDGE DRIVE SANTA ROSA VALLEY, CA 93012 | BLUE CROSS OF CALIFORNIA | $7K | — | $7K | 0.78% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INS SERVICES INC. | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | BLUE CROSS OF CALIFORNIA | $1K | — | $1K | 0.13% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | PROVIDENCE HEALTH PLAN | $16K | — | $16K | 3.00% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | KAISER FOUNDATION HEALTH PLAN INC | $14K | — | $14K | 5.67% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS SVCS | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN INC | — | $215 | $215 | 0.09% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | KAISER FOUNDATION HEALTH PLAN INC | $9K | — | $9K | 4.26% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WORD & BROWN INS ADMNISTRATORS | 721 S PARKER STREET, SUITE 300 ORANGE, CA 92868 | KAISER FOUNDATION HEALTH PLAN INC | $3K | — | $3K | 1.28% |
| ADVANTAGE INSURANCE SERVICES, INC.3 Filed as: ADVANTAGE INSURANCE SERVICES, INC | 1580 MAKALOA ST, SUITE 1220 HONOLULU, HI 36814 | UNIVERSITY HEALTH ALLIANCE | $2K | — | $2K | 1.65% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $3K | — | $3K | 5.26% |
| CAREMASTER INSURANCE AGENCY INC3 | 12474 RIDGE DRIVE SANTA ROSA VALLEY, CA 93012 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $378 | — | $378 | 0.78% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INS SERVICES INC. | 32110 AGOURA ROA WESTLAKE VILLAGE, CA 91361 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $65 | — | $65 | 0.13% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | ANTHEM LIFE INSURANCE COMPANY | $1K | — | $1K | 5.26% |
| CAREMASTER INSURANCE AGENCY INC3 | 12474 RIDGE DRIVE SANTA ROSA VALLEY, CA 93012 | ANTHEM LIFE INSURANCE COMPANY | $211 | — | $211 | 0.78% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INS SERVICES INC. | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | ANTHEM LIFE INSURANCE COMPANY | $36 | — | $36 | 0.13% |
| ADVANTAGE INSURANCE SERVICES, INC.3 Filed as: ADVANTAGE INSURANCE SERVICES, INC | 1580 MAKALOA ST, SUITE 1220 HONOLULU, HI 96814 | HAWAII DENTAL SERVICE | $111 | — | $111 | 3.00% |
| VARIOUS - SEE ATTACHED3 Filed as: AFLAC - SEE ATTACHMENT | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $236 | — | $236 | 9.12% |
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 | 2,440 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,447 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(9 contracts, 6 carriers) | BLUE CROSS OF CALIFORNIA | 347 | $8.6M |
| Dental(4 contracts, 3 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 2,094 | $2.4M |
| Vision(4 contracts, 3 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 2,094 | $2.6M |
| Life insurance(2 contracts) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 2,094 | $1.5M |
| Short-term disability(2 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 2,094 | $1.5M |
| Long-term disability(2 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 2,094 | $1.5M |
| Prescription drug(9 contracts, 6 carriers) | BLUE CROSS OF CALIFORNIA | 347 | $8.6M |
| Other(4 contracts, 3 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 2,094 | $2.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,094 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.