| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ORION RISK MANAGEMENT | 245 S. LOS ROBLES AVE., SUITE 400 PASADENA, CA 91101 | KAISER FOUNDATION HEALTH PLAN INC. | $42K | — | $42K | 3.37% |
| BENEFITS AMERICA INSURANCE SERVICES3 | 6320 CANOGA AVE., 12TH FLOOR WOODLAND HILLS, CA 91367 | KAISER FOUNDATION HEALTH PLAN INC. | $21K | — | $21K | 1.66% |
| ACRISURE LLC3 Filed as: ORION RISK MANAGEMENT | 245 S. LOS ROBLES AVE., SUITE 400 PASADENA, CA 91101 | AETNA HEALTH, INC. | $6K | — | $6K | 0.78% |
| BENEFITS AMERICA INSURANCE SERVICES | 6320 CANOGA AVE., 12TH FLOOR WOODLAND HILLS, CA 91367 | AETNA HEALTH, INC. | — | — | $0 | 0.00% |
| BENEFITS AMERICA INSURANCE SERVICES3 | 6320 CANOGA AVE., 12TH FLOOR WOODLAND HILLS, CA 91367 | AETNA LIFE INSURANCE COMPANY | $11K | $5K | $16K | 6.01% |
| ACRISURE LLC3 Filed as: ORION RISK MANAGEMENT | 245 S. LOS ROBLES AVE., SUITE 400 PASADENA, CA 91101 | AETNA LIFE INSURANCE COMPANY | $2K | — | $2K | 0.79% |
| BENEFITS AMERICA INSURANCE SERVICES3 | 6320 CANOGA AVE., 12TH FLOOR WOODLAND HILLS, CA 91367 | UNITED CONCORDIA INSURANCE COMPANY | $13K | — | $13K | 6.73% |
| ACRISURE LLC3 Filed as: ORION RISK MANAGEMENT | 245 S. LOS ROBLES AVE., SUITE 400 PASADENA, CA 91101 | UNITED CONCORDIA INSURANCE COMPANY | $7K | — | $7K | 3.25% |
| BENEFITS AMERICA INSURANCE SERVICES3 | 6320 CANOGA AVE., 12TH FLOOR WOODLAND HILLS, CA 91367 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | — | $6K | 8.34% |
| ACRISURE LLC3 Filed as: ORION RISK MANAGEMENT | 245 S. LOS ROBLES AVE., SUITE 400 PASADENA, CA 91101 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 1.66% |
| BENEFITS AMERICA INSURANCE SERVICES3 | 6320 CANOGA AVE., 12TH FLOOR WOODLAND HILS, CA 91367 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 8.41% |
| ACRISURE LLC3 Filed as: ORION RISK MANAGEMENT | 245 S. LOS ROBLES AVE., SUITE 400 PASADENA, CA 91101 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $490 | — | $490 | 1.59% |
| ACRISURE LLC3 Filed as: ORION RISK MANAGEMENT | 245 S. LOS ROBLES AVE., SUITE 400 PASADENA, CA 91101 | VISION SERVICE PLAN | $249 | — | $249 | 0.93% |
| BENEFITS AMERICA INSURANCE SERVICES3 | 6320 CANOGA AVE., 12TH FLOOR WOODLAND HILLS, CA 91367 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 8.44% |
| ACRISURE LLC3 Filed as: ORION RISK MANAGEMENT | 245 S. LOS ROBLES AVE., SUITE 400 PASADENA, CA 91101 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $391 | — | $391 | 1.57% |
| BENEFITS AMERICA INSURANCE SERVICES3 | 6320 CANOGA AVE., 12TH FLOOR WOODLAND HILLS, CA 91367 | UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. | $915 | — | $915 | 6.47% |
| ACRISURE LLC3 Filed as: ORION RISK MANAGEMENT | 245 S. LOS ROBLES AVE., SUITE 400 PASADENA, CA 91101 | UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. | $500 | — | $500 | 3.53% |
| BENEFITS AMERICA INSURANCE SERVICES3 | 6320 CANOGA AVE., 12TH FLOOR WOODLAND HILLS, CA 91367 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $599 | — | $599 | 8.43% |
| ACRISURE LLC3 Filed as: ORION RISK MANAGEMENT | 245 S. LOS ROBLES AVE., SUITE 400 PASADENA, CA 91101 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $112 | — | $112 | 1.58% |
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 | 279 | 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) | 282 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 342 | $2.3M |
| Dental(2 contracts, 2 carriers) | UNITED CONCORDIA INSURANCE COMPANY | 159 | $214K |
| Vision | VISION SERVICE PLAN | 168 | $27K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 279 | $96K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 279 | $7K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 279 | $31K |
| Prescription drug(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 342 | $2.3M |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 279 | $96K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 342 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.