| 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. | $55K | — | $55K | 5.04% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 2677 N MAIN ST STE 800 SANTA ANA, CA 92705 | KAISER FOUNDATION HEALTH PLAN, INC. | $16K | — | $16K | 1.44% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3 POLARIS WAY 4TH FLOOR ALISO VIEJO, CA 92656 | CALIFORNIA PHYSICIANS' SERVICE | $25K | — | $25K | 4.99% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 1600 W HILLSDALE BLVD SUITE 201 SAN MATEO, CA 94402 | CALIFORNIA PHYSICIANS' SERVICE | — | $7K | $7K | 1.50% |
| ACRISURE LLC3 Filed as: ACRISURE SOUTHWEST PARTNERS | INSURANCE 4000 WESTERLY PL, STE 110 NEWPORT BEACH, CA 92660 | PRINCIPAL LIFE INSURANCE COMPANY | $17K | — | $17K | 10.97% |
| GA SOLUTIONS LLC3 | 311 CLOCK TOWER CMNS BREWSTER, NY 10509 | PRINCIPAL LIFE INSURANCE COMPANY | — | $7K | $7K | 4.32% |
| ACRISURE LLC3 | PO BOX 1788 GRAND RAPIDS, MI 49501 | PRINCIPAL LIFE INSURANCE COMPANY | — | $674 | $674 | 0.45% |
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 | 151 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 153 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 178 | $1.6M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 243 | $151K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 243 | $151K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 243 | $151K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 88 | $493K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 243 | — |
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.