| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 423 MCGOARTY STREET SAN GABRIEL, CA 91776 | BLUE CROSS OF CALIFORNIA | $67K | — | $67K | 4.54% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3130 S HARBOR BLVD STE 140 SANTA ANA, CA 92704 | KAISER FOUNDATION HEALTH PLAN INC | $28K | — | $28K | 5.01% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3 POLARIS WAY 4TH FLOOR ALISO VIEJO, CA 92656 | THE GUARDIAN LIFE INSURANCE COMPANY | $15K | $11K | $26K | 11.18% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3130 S HARBOR BLVD STE 140 SANTA ANA, CA 92704 | VISION SERVICE PLAN | $1K | — | $1K | 4.57% |
| GROUP BENEFITS LTD3 Filed as: GROUP BENEFITS, LTD | 12006 RIDGEMONT DR URBANDALE, IA 50323 | VISION SERVICE PLAN | $729 | — | $729 | 2.64% |
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 | 246 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 249 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 251 | $2.0M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY | 264 | $232K |
| Vision(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 251 | $1.5M |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY | 264 | $232K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY | 264 | $232K |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY | 264 | $232K |
| 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.