| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: LBW INSURANCE & FINANCIAL SERVICES | 28055 SMYTH DRIVE VALENCIA, CA 91355 | BLUE CROSS OF CALIFORNIA | $24K | — | $24K | 2.72% |
| MESIROW INSURANCE SERVICES INC3 | 353 NORTH CLARK STREET CHICAGO, IL 60654 | BLUE CROSS OF CALIFORNIA | $24K | — | $24K | 2.70% |
| MESIROW INSURANCE SERVICES INC3 Filed as: MESIROW INS SERVICES INC | 353 NORTH CLARK STREET CHICAGO, IL 60654 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $5 | $6K | $6K | 6.03% |
| ACRISURE LLC3 Filed as: LBW INS & FINANCIAL SERVICES | 28055 SMYTH DRIVE VALENCIA, CA 91355 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 5.81% |
| MESIROW INSURANCE SERVICES INC3 Filed as: MESIROW INS SERVICES INC | 353 NORTH CLARK STREET CHICAGO, IL 60654 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 4.19% |
| MESIROW INSURANCE SERVICES INC3 Filed as: MESIROW INSURANCE SERVICES, INC. | 353 NORTH CLARK STREET CHICAGO, IL 60654 | CONTINENTAL AMERICAN INSURANCE COMPANY | $12K | — | $12K | 21.60% |
| COURTNEY RYAN YURCZYK3 Filed as: COURTNEY S YURCZYK | 1601 WEST 55TH STREET LA GRANGE, IL 60525 | CONTINENTAL AMERICAN INSURANCE COMPANY | $831 | — | $831 | 1.49% |
| MICHAEL ROBERT YURCZYK3 Filed as: MICHAEL R YURCZYK | 111 WEST JACKSON BOULEVARD 17TH FLOOR CHICAGO, IL 60654 | CONTINENTAL AMERICAN INSURANCE COMPANY | $343 | — | $343 | 0.61% |
| ADAM H MICHAELS3 | 12121 WILSHIRE BOULEVARD SUITE 1000 LOS ANGELES, CA 90025 | CONTINENTAL AMERICAN INSURANCE COMPANY | $312 | — | $312 | 0.56% |
| MICHAEL C WALKER3 Filed as: MICHAEL A STACHOWIAK | 25 FALCON HILLS DRIVE HIGHLANDS RANCH, CO 80126 | CONTINENTAL AMERICAN INSURANCE COMPANY | $87 | — | $87 | 0.16% |
| CHRISTOPHER HAGER3 Filed as: CHRISTOPHER A HAGER | 12121 WILSHIRE BOULEVARD SUITE 1000 LOS ANGELES, CA 90025 | CONTINENTAL AMERICAN INSURANCE COMPANY | $87 | — | $87 | 0.16% |
| MESIROW INSURANCE SERVICES INC3 Filed as: MESIROW INSURANCE SERVICE | 353 NORTH CLARK STREET SUITE 1100 CHICAGO, IL 60610 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $323 | $2K | 11.55% |
| MESIROW INSURANCE SERVICES INC3 Filed as: MESIROW INSURANCE SERVICE | 353 NORTH CLARK STREET SUITE 1100 CHICAGO, IL 60610 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $347 | $30 | $377 | 10.86% |
| MESIROW INSURANCE SERVICES INC3 Filed as: MESIROW INSURANCE SERVICE | 353 NORTH CLARK STREET SUITE 1100 CHICAGO, IL 60610 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $271 | $39 | $310 | 11.44% |
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 | 134 | 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) | 134 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 135 | $886K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 134 | $96K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 134 | $96K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 207 | $21K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 12 | $3K |
| Other(4 contracts, 2 carriers) | CONTINENTAL AMERICAN INSURANCE COMPANY | 207 | $83K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 207 | — |
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.