| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | CALIFORNIA PHYSICIANS SERVICE | $198 | $7K | $7K | 6.44% |
| AMWINS5 Filed as: LISI INC. | 1600 HILLDALE BLVD. SAN MATEO, CA 94402 | CALIFORNIA PHYSICIANS SERVICE | — | $2K | $2K | 2.13% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $594 | — | $594 | 5.00% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $646 | — | $646 | 10.00% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $242 | — | $242 | 10.00% |
| PAYCHEX INSURANCE AGENCY, INC.5 Filed as: PAYCHEX INS AGENCY INC | 150 SAWGRASS DRIVE ROCHESTER, NY 14620 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $62 | $62 | 2.56% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $179 | — | $179 | 10.01% |
| PAYCHEX INSURANCE AGENCY, INC.5 Filed as: PAYCHEX INS AGENCY INC | 150 SAWGRASS DRIVE ROCHESTER, NY 14620 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $62 | $62 | 3.47% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $185 | — | $185 | 14.97% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $118 | — | $118 | 9.97% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $92 | — | $92 | 9.95% |
| LONDONO MILLER BENEFITS INC4 | 28326 ATLEY COURT SAUGUS, CA 91350 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $39 | — | $39 | 5.09% |
| ACRISURE LLC4 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $32 | — | $32 | 4.18% |
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 | 125 | 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) | 125 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA PHYSICIANS SERVICE | 113 | $116K |
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 117 | $12K |
| Vision | CALIFORNIA PHYSICIANS SERVICE | 113 | $116K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 125 | $4K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 56 | $1K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 125 | $1K |
| Prescription drug | CALIFORNIA PHYSICIANS SERVICE | 113 | $116K |
| Other(5 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 125 | $12K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 125 | — |
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.