| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3130 S HARBOR BLVD STE 140 SANTA ANA, CA 92704 | KAISER FOUNDATION HEALTH PLAN, INC. | $65K | — | $65K | 4.77% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 2677 N MAIN ST STE 800 SANTA ANA, CA 92705 | KAISER FOUNDATION HEALTH PLAN, INC. | $20K | — | $20K | 1.50% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3 POLARIS WAY 4TH FLOOR ALISO VIEJO, CA 92656 | BLUE OF CALIFORNIA | $19K | — | $19K | 5.00% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 1600 W HILLSDALE BLVD SUITE 201 SAN MATEO, CA 94402 | BLUE OF CALIFORNIA | — | $6K | $6K | 1.50% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | DBA THE LBL INSURANCE 3 POLARIS WAY FL 4 ALISO VIEJO, CA 92656 | PRINCIPAL LIFE INSURANCE COMPANY | $16K | — | $16K | 10.29% |
| GA SOLUTIONS LLC3 | 311 CLOCK TOWER CMNS BREWSTER, NY 10509 | PRINCIPAL LIFE INSURANCE COMPANY | $6K | — | $6K | 4.02% |
| ACRISURE LLC3 | PO BOX 1788 GRAND RAPIDS, MI 49501 | PRINCIPAL LIFE INSURANCE COMPANY | — | $4K | $4K | 2.58% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | DBA BENEFITS DONE RIGHT 601 UNIVERSITY AVE STE 250 SACRAMENTO, CA 95825 | PRINCIPAL LIFE INSURANCE COMPANY | — | $960 | $960 | 0.62% |
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 | 396 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 398 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 181 | $1.7M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 244 | $155K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 244 | $155K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 244 | $155K |
| Prescription drug | BLUE OF CALIFORNIA | 65 | $385K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 244 | — |
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.