| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS SVCS LLC | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | KAISER FOUNDATION HEALTH PLAN INC. | $44K | — | $44K | 5.41% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS SVCS LLC | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | UNITED CONCORDIA INSURANCE COMPANY | $8K | — | $8K | 10.81% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS SVCS LLC | 550 S. HOPE STREET, SUITE 1000 LOS ANGELES, CA 90071 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $374 | $6K | 21.43% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS SVCS LLC | 550 S. HOPE STREET, SUITE 1000 LOS ANGELES, CA 90071 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $148 | $4K | 26.08% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS SVCS INC | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | FIDELITY SECURITY LIFE INSURANCE COMPANY (EYEMED VISION CARE) | $1K | — | $1K | 9.13% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS SVCS LLC | 550 S. HOPE STREET, SUITE 1000 LOS ANGELES, CA 90071 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $126 | $126 | 1.12% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS SVCS LLC | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. | $555 | — | $555 | 10.83% |
| VAIOUS - SEE ATTACHMENT3 | C/O AFLAC 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $659 | $19 | $678 | 16.21% |
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 | 121 | 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) | 121 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC. | 154 | $819K |
| Dental(2 contracts, 2 carriers) | UNITED CONCORDIA INSURANCE COMPANY | 80 | $79K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY (EYEMED VISION CARE) | 179 | $13K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 121 | $40K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 121 | $11K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 154 | $819K |
| Other(4 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 121 | $55K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 179 | — |
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.