| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 3130 SOUTH HARBOR BOULEVARD SUITE 140 SANTA ANA, CA 92704 | KAISER FOUNDATION HEALTH PLAN, INC. | $15K | $0 | $15K | 2.29% |
| ADVOCATE, INC.3 | 228 PARK AVENUE SOUTH NEW YORK, NY 10003 | KAISER FOUNDATION HEALTH PLAN, INC. | $13K | $0 | $13K | 2.01% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 100 OTTAWA AVENUE SW GRAND RAPIDS, MI 49503 | SUN LIFE ASSURANCE COMPANY OF CANADA | $14K | $5K | $19K | 5.06% |
| ADVOCATE, INC.3 | 228 PARK AVENUE SOUTH NEW YORK, NY 10003 | SUN LIFE ASSURANCE COMPANY OF CANADA | $10K | $0 | $10K | 2.70% |
| GROUP BENEFITS LTD3 Filed as: GROUP BENEFITS, LTD | 12006 RIDGEMONT DRIVE URIBANDALE, IA 50323 | SUN LIFE ASSURANCE COMPANY OF CANADA | $0 | $10K | $10K | 2.64% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 3 POLARIS WAY, 4TH FLOOR ALISO VIEJO, CA 92656 | VISION SERVICES PLAN | $2K | $0 | $2K | 5.09% |
| ADVOCATE, INC.3 | 228 PARK AVENUE SOUTH NEW YORK, NY 10003 | VISION SERVICES PLAN | $2K | $0 | $2K | 4.90% |
| GROUP BENEFITS LTD3 Filed as: GROUP BENEFITS, LTD. | 12006 RIDGEMONT DRIVE URIBANDALE, IA 50323 | VISION SERVICES PLAN | $1K | $0 | $1K | 3.99% |
| EMPLOYEE NAVIGATOR, LLC3 | 7979 OLD GEORGETOWN ROAD, SUITE 300 BETHESDA, MD 20814 | VISION SERVICES PLAN | $146 | $0 | $146 | 0.47% |
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 | 106 | 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) | 106 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN, INC. | 101 | $659K |
| Dental | SUN LIFE ASSURANCE COMPANY OF CANADA | 250 | $370K |
| Vision | VISION SERVICES PLAN | 159 | $31K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 250 | $370K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 250 | $370K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 250 | $370K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN, INC. | 101 | $659K |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 250 | $370K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 250 | — |
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.