| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DOUG FREE AND ASSOCIATES, INC.3 | 16 N MARENGO AVENUE, SUITE 417 PASADENA, CA 91101 | KAISER FOUNDATION HEALTH PLAN INC. | $32K | — | $32K | 3.44% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | KAISER FOUNDATION HEALTH PLAN INC. | $6K | — | $6K | 0.65% |
| DOUG FREE AND ASSOCIATES, INC.3 | 16 N MARENGO AVENUE, SUITE 417 PASADENA, CA 91101 | AETNA LIFE INSURANCE COMPANY | $3K | — | $3K | 3.45% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | AETNA LIFE INSURANCE COMPANY | $454 | — | $454 | 0.62% |
| DINORAH ROSSANA DEVALLY3 | 361 MISTY TRAILS PLACE SIMI VALLEY, CA 93065 | AFLAC | $2K | — | $2K | 5.98% |
| RICHARD J KUNZ3 | 351 CALIFORNIA STREET, SUITE 450 SAN FRANCISCO, CA 94104 | AFLAC | $420 | — | $420 | 1.62% |
| ADAM H MICHAELS3 | 12121 WILSHIRE BLVD, SUITE 1225 LOS ANGELES, CA 90025 | AFLAC | $237 | — | $237 | 0.92% |
| RENEE SUZANNE CORSO3 | 5805 SEPULVEDA BLVD., SUITE 740 SHERMAN OAKS, CA 91411 | AFLAC | $172 | — | $172 | 0.66% |
| BRIAN G JAEGGI3 | 5112 TOPANGA CANYON BLVD WOODLAND HILLS, CA 91364 | AFLAC | $7 | — | $7 | 0.03% |
| TERRANCE L YEAGER3 Filed as: TERRANCE LEE YEAGER | 41 E FOOTHILL BLVD, SUITE 204 ARCADIA, CA 91006 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | — | $2K | 7.75% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $347 | — | $347 | 1.73% |
| TERRANCE L YEAGER3 Filed as: TERRANCE LEE YEAGER | 41 E FOOTHILL BLVD, SUITE 204 ARCADIA, CA 91006 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $1K | — | $1K | 11.57% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $394 | — | $394 | 3.43% |
| TERRANCE L YEAGER3 Filed as: TERRANCE LEE YEAGER | 41 E FOOTHILL BLVD, SUITE 204 ARCADIA, CA 91006 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $1K | — | $1K | 12.25% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $307 | — | $307 | 2.75% |
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 | 200 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 203 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC. | 177 | $933K |
| Dental | AETNA LIFE INSURANCE COMPANY | 224 | $73K |
| Life insurance(3 contracts, 2 carriers) | AFLAC | 126 | $57K |
| Short-term disability | AFLAC | 15 | $26K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 7 | $11K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 177 | $933K |
| Other(3 contracts, 3 carriers) | AFLAC | 175 | $48K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 224 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.