| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 3110 E GUASTI ROAD SUITE 500 ONTARIO, CA 91761 | HEALTH NET | $36K | $0 | $36K | 4.14% |
| COMBINED SERVICES LLC3 Filed as: COMBINED BENEFITS, INC. | 1520 BRIDGEGATE DR SUITE 108 DIAMOND BAR, CA 91765 | HEALTH NET | $7K | $0 | $7K | 0.86% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3110 E GUASTI ROAD SUITE 500 ONTARIO, CA 917611228 | HUMANA INSURANCE COMPANY | $8K | $0 | $8K | 6.63% |
| COMBINED SERVICES LLC3 Filed as: COMBINED BENEFITS, INC. | 1520 BRIDGEGATE DR SUITE 108 DIAMOND BAR, CA 917653937 | HUMANA INSURANCE COMPANY | $2K | $0 | $2K | 1.38% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 3110 E GUASTI ROAD SUITE 500 ONTARIO, CA 917611228 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $192 | $3K | 13.34% |
| COMBINED SERVICES LLC3 Filed as: COMBINED BENEFITS, INC. | 1520 BRIDGEGATE DR SUITE 108 DIAMOND BAR, CA 917653937 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $550 | $0 | $550 | 2.55% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3110 E GUASTI ROAD SUITE 500 ONTARIO, CA 917611228 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $152 | $2K | 13.35% |
| COMBINED SERVICES LLC3 Filed as: COMBINED BENEFITS, INC. | 1520 BRIDGEGATE DR SUITE 108 DIAMOND BAR, CA 917653937 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $426 | $0 | $426 | 2.56% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 3110 E GUASTI ROAD SUITE 500 ONTARIO, CA 917611228 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $984 | $97 | $1K | 9.13% |
| COMBINED SERVICES LLC3 Filed as: COMBINED BENEFITS, INC. | 1520 BRIDGEGATE DR SUITE 108 DIAMOND BAR, CA 917653937 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $200 | $0 | $200 | 1.69% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 3110 E GUASTI ROAD SUITE 500 ONTARIO, CA 917611228 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $751 | $85 | $836 | 9.37% |
| COMBINED SERVICES LLC3 Filed as: COMBINED BENEFITS, INC. | 1520 BRIDGEGATE DR SUITE 108 DIAMOND BAR, CA 917653937 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $141 | $0 | $141 | 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 | 177 | 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) | 177 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTH NET | 134 | $865K |
| Dental | HUMANA INSURANCE COMPANY | 149 | $121K |
| Vision | HUMANA INSURANCE COMPANY | 149 | $121K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 170 | $38K |
| Other(4 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 170 | $59K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 170 | — |
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.