| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRIVNE, CA 92614 | KAISER FOUNDATION HEALTH PLAN INC. | $35K | — | $35K | 2.53% |
| CENTENNIAL GROUP BENEFITS3 Filed as: CENTENNIAL GROUP BENEFITS & INS SVC | PO BOX 3387 SEAL BEACH, CA 90740 | KAISER FOUNDATION HEALTH PLAN INC. | $33K | — | $33K | 2.40% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | DELTA DENTAL OF CALIFORNIA | $7K | — | $7K | 6.04% |
| CENTENNIAL GROUP BENEFITS3 Filed as: CENTENNIAL GROUP BENEFITS & INS SVC | PO BOX 3387 SEAL BEACH, CA 90740 | DELTA DENTAL OF CALIFORNIA | $4K | — | $4K | 3.96% |
| CENTENNIAL GROUP BENEFITS INSURANCE3 Filed as: CENTENNIAL BENEFITS & INS SVCS INC. | PO BOX 3387 SEAL BEACH, CA 90740 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $322 | $4K | 6.73% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 2.16% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | DELTA DENTAL OF CALIFORNIA | $1K | — | $1K | 5.00% |
| CENTENNIAL GROUP BENEFITS3 Filed as: CENTENNIAL GROUP BENEFITS & INS SVC | PO BOX 3387 SEAL BEACH, CA 90740 | DELTA DENTAL OF CALIFORNIA | $1K | — | $1K | 4.33% |
| CENTENNIAL GROUP BENEFITS INSURANCE3 Filed as: CENTENNIAL BENEFITS & INS SVCS INC. | PO BOX 3387 SEAL BEACH, CA 90740 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $167 | $3K | 11.56% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 8.16% |
| CENTENNIAL GROUP BENEFITS3 Filed as: CENTENNIAL GROUP BENEFITS & INS SVC | PO BOX 3387 SEAL BEACH, CA 90740 | VISION SERVICE PLAN | $604 | — | $604 | 4.14% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | VISION SERVICE PLAN | $310 | — | $310 | 2.12% |
| CENTENNIAL GROUP BENEFITS INSURANCE3 Filed as: CENTENNIAL BENEFITS & INS SVCS INC. | PO BOX 3387 SEAL BEACH, CA 90740 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $634 | — | $634 | 5.47% |
| BENEFIT ADVISORS NETWORK LLC3 Filed as: BENEFIT ADVISORS NETWORK | 6830 COCHRAN ROAD SOLON, OH 44139 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $20 | $20 | 0.17% |
| CENTENNIAL GROUP BENEFITS INSURANCE3 Filed as: CENTENNIAL BENEFITS & INS SVCS INC. | PO BOX 3387 SEAL BEACH, CA 90740 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $567 | $5 | $572 | 5.62% |
| CENTENNIAL GROUP BENEFITS3 Filed as: CENTENNIAL GROUP BENEFITS & INS SVC | 245 FISHER AVENUE, SUITE A-2 COSTA MESA, CA 92626 | MANAGED HEALTH NETWORK | $253 | — | $253 | 2.54% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | MANAGED HEALTH NETWORK | $246 | — | $246 | 2.47% |
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 | 263 | 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) | 263 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC. | 250 | $1.4M |
| Dental(2 contracts) | DELTA DENTAL OF CALIFORNIA | 100 | $137K |
| Vision | VISION SERVICE PLAN | 109 | $15K |
| Life insurance(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 264 | $100K |
| Short-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 264 | $76K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 264 | $64K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 250 | $1.4M |
| Other(4 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 264 | $109K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 264 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.