| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $15K | $2K | $17K | 11.27% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | $10K | $18K | 32.67% |
| BENEFITS MATCHMAKING LLC3 Filed as: BENEFITS MATCHMAKING,LLC | P.O. BOX 1788 GRAND RAPIDS, MI 49501 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $745 | $745 | 1.32% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | $587 | $8K | 16.20% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $275 | $3K | 11.22% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | P.O. BOX 1788 GRAND RAPIDS, MI 49501 | CALIFORNIA DENTAL NETWORK, INC. | $2K | — | $2K | 10.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $147 | $2K | 16.21% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $815 | $67 | $882 | 16.25% |
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 | 378 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 386 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC. | 194 | $1.4M |
| Dental(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 170 | $170K |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 231 | $23K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 372 | $62K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 378 | $12K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 378 | $49K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 194 | $1.4M |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 372 | $62K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 378 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.