| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | KAISER FOUNDATION HEALTH PLAN INC. | $18K | — | $18K | 4.47% |
| ADSH INVESTMENTS3 | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $10K | — | $10K | 9.21% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $9K | $193 | $9K | 10.22% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DRIVE URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $4K | $4K | 5.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $288 | $3K | 11.23% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DRIVE URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 5.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC2426 | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $188 | $3K | 16.17% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DRIVE URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $808 | $808 | 5.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $887 | $125 | $1K | 10.32% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DRIVE URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $444 | $444 | 4.53% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $946 | $111 | $1K | 11.17% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DRIVE URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $473 | $473 | 5.00% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DRIVE URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $219 | $219 | 5.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $49 | $49 | 1.12% |
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 | 259 | 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) | 259 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC. | 60 | $411K |
| Dental | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 143 | $109K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 143 | $109K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 258 | $33K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 20 | $10K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 259 | $89K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 60 | $411K |
| Stop-loss / reinsurancereinsurance | AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXAS | 113 | $324K |
| Other(4 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 258 | $53K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 259 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.