| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BENEFIT HEALTH ADVISOR3 | — | GERBER LIFE | $51K | — | $51K | 9.98% |
| ACRISURE LLC3 Filed as: ACRISURE OF CA LLC DBA PCS INSURANC | 100 OTTAWA AVENUE SOUTHWEST GRAND RAPIDS, MI 49503 | TRANSAMERICA LIFE INSURANCE COMPANY | $8K | — | $8K | 25.69% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA | 250 VALLOMBROSA AVENUE SUITE 250 CHICO, CA 95926 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $227 | $2K | 10.36% |
| PACIFIC COAST BENEFITS, LLC3 Filed as: PACIFIC COAST BENEFITS | PO BOX 1749 GILROY, CA 95021 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $156 | — | $156 | 0.78% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA | 250 VALLOMBROSA AVENUE SUITE 250 CHICO, CA 95926 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $178 | $2K | 10.20% |
| PACIFIC COAST BENEFITS, LLC3 Filed as: PACIFIC COAST BENEFITS | PO BOX 1749 GILROY, CA 95021 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $144 | — | $144 | 0.81% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA | 250 VALLOMBROSA AVENUE SUITE 250 CHICO, CA 95926 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $692 | $76 | $768 | 10.19% |
| PACIFIC COAST BENEFITS, LLC3 Filed as: PACIFIC COAST BENEFITS | PO BOX 1749 GILROY, CA 95021 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $61 | — | $61 | 0.81% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA | 250 VALLOMBROSA AVENUE SUITE 250 CHICO, CA 95926 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $278 | $30 | $308 | 10.16% |
| PACIFIC COAST BENEFITS, LLC3 Filed as: PACIFIC COAST BENEFITS | PO BOX 1749 GILROY, CA 95021 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $25 | — | $25 | 0.82% |
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 | 117 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 117 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 117 | $23K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 117 | $8K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 117 | $18K |
| Stop-loss / reinsurancereinsurance | GERBER LIFE | 115 | $512K |
| Other(3 contracts, 2 carriers) | TRANSAMERICA LIFE INSURANCE COMPANY | 117 | $53K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 117 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.