| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARTIN J WOLFF & CO INC INS AGENTS3 Filed as: MARTIN J. WOLFF CO., INC. | 4311 WILSHIRE BLVD STE 412 LOS ANGELES, CA 90010 | KAISER FOUNDATION HEALTH PLAN INC | $28K | $0 | $28K | 2.26% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 5664 PRAIRIE CREEK DR SE CAALEDONIA, MI 49316 | KAISER FOUNDATION HEALTH PLAN INC | $21K | $0 | $21K | 1.70% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 500 N BRAND BLVD STE 100 GLENDALE, CA 91203 | KAISER FOUNDATION HEALTH PLAN INC | $16K | $0 | $16K | 1.29% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | — | DELTA DENTAL OF CALIFORNIA | $2K | $0 | $2K | 3.34% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | — | DELTA DENTAL OF CALIFORNIA | $1K | $0 | $1K | 1.66% |
| MARTIN J WOLFF & CO INC INS AGENTS3 Filed as: MARTIN J WOFF & CO INC AGENTS | 4311 WILSHIRE BLVD STE 412 LOS ANGELES, CA 90010 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $2K | $3K | 6.11% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 STONY POINT RD STE 160 SANTA ROSA, CA 95401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $0 | $3K | 5.07% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 505 N BRAND BLVD FLOOR 6 GLENDALE, CA 91203 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 4.03% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 736 S STONE AVE LA GRANGE, IL 60525 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $782 | $782 | 1.37% |
| MARTIN J WOLFF & CO INC INS AGENTS3 | 4311 WILSHIRE BLVD STE 412 LOS ANGELES, CA 90010 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $2K | $3K | 7.91% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 STONY POINT RD STE 160 SANTA ROSA, CA 95401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 6.34% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 505 N BRAND BLVD FLOOR 5 GLENDALE, CA 91203 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 5.04% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 736 S STONE AVE LA GRANGE, IL 60525 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $522 | $522 | 1.36% |
| ACRISURE LLC3 Filed as: ACIRSURE OF CALIFORNIA, LLC | 1950 W CORPORATE WAY ANAHEIM, CA 92801 | VISION SERVICE PLAN | $785 | $0 | $785 | 3.66% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | PO BOX 95287 CHICAGO, IL 60694 | VISION SERVICE PLAN | $545 | $0 | $545 | 2.54% |
| MARTIN J WOLFF & CO INC INS AGENTS3 | 4311 WILSHIRE BLVD STE 412 LOS ANGELES, CA 90010 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $418 | $1K | $2K | 9.01% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 STONY POINT RD STE 160 SANTA ROSA, CA 95401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $837 | $0 | $837 | 4.04% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 505 N BRAND BLVD FLOOR 6 GLENDALE, CA 91203 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $817 | $0 | $817 | 3.94% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 736 S STONE AVE LA GRANGE, IL 60525 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $262 | $262 | 1.26% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 1950 W CORPORATE WAY ANAHEIM, CA 92801 | DELTA DENTAL OF CALIFORNIA | $1K | $0 | $1K | 6.38% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | — | DELTA DENTAL OF CALIFORNIA | $725 | $0 | $725 | 3.62% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 STONY POINT RD STE 160 SANTA ROSA, CA 95401 | UNITED OF OMAHA INSURANCE COMPANY | $563 | $0 | $563 | 4.26% |
| MARTIN J WOLFF & CO INC INS AGENTS3 Filed as: MARTIN J WOLFF & CO IN INS AGENTS | 4311 WILSHIRE BLVD STE 412 LOS ANGELES, CA 90010 | UNITED OF OMAHA INSURANCE COMPANY | $316 | $145 | $461 | 3.49% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 505 N BRAND BLVD FLOOR 6 GLENDALE, CA 91203 | UNITED OF OMAHA INSURANCE COMPANY | $442 | $0 | $442 | 3.35% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 736 S STONE AVE LA GRANGE, IL 60525 | UNITED OF OMAHA INSURANCE COMPANY | $0 | $202 | $202 | 1.53% |
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 | 229 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 232 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 155 | $1.2M |
| Dental(2 contracts) | DELTA DENTAL OF CALIFORNIA | 154 | $92K |
| Vision | VISION SERVICE PLAN | 122 | $21K |
| Life insurance(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 243 | $70K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 41 | $21K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 241 | $38K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 243 | $70K |
| 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.