| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ORION RISK MANAGEMENT INS. SERVICES | 1800 QUAIL STREET, SUITE 110 NEWPORT BEACH, CA 92660 | KAISER FOUNDATION HEALTH PLAN, INC. | $52K | $0 | $52K | 3.02% |
| ACRISURE LLC3 Filed as: ORION RISK MANAGEMENT INS. SERVICES | 1 SOUTH FAIR OAKS AVENUE, SUITE 402 PASADENA, CA 91105 | CALIFORNIA CHOICE | $13K | $0 | $13K | 5.00% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SVCS, LLC | UNKNOWN LOS ANGELES, CA 90026 | CALIFORNIA CHOICE | $8K | $0 | $8K | 3.00% |
| BENEFITS AMERICA INSURANCE SERVICES3 | UNKNOWN LOS ANGELES, CA 90026 | UNITED CONCORDIA INSURANCE COMPANY | $14K | $4K | $18K | 13.96% |
| BENEFITS AMERICA INSURANCE SERVICES3 | 1800 QUAIL STREET, SUITE 110 NEWPORT BEACH, CA 92660 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $11K | $5K | $16K | 13.43% |
| PAYCOM PAYROLL LLC5 Filed as: PAYCOM PAYROLL, LLC | 7501 WEST MEMORIAL ROAD OKLAHOMA CITY, OK 73142 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $4K | $4K | 2.98% |
| BENEFITS AMERICA INSURANCE SERVICES3 | 1800 QUAIL STREET, SUITE 110 NEWPORT BEACB, CA 92660 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $587 | $2K | 1.51% |
| BENEFITS AMERICA INSURANCE SERVICES3 | UNKNOWN LOS ANGELES, CA 90026 | UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. | $348 | $105 | $453 | 13.30% |
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 | 222 | 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) | 222 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 210 | $2.0M |
| Dental(2 contracts, 2 carriers) | UNITED CONCORDIA INSURANCE COMPANY | 248 | $130K |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 263 | $118K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 263 | $118K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 263 | $118K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 263 | $118K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 210 | $2.0M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 263 | $118K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 263 | — |
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.