| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BENEFITS AMERICA INSURANCE SERVICES3 | 6320 CANOGA AVENUE SUITE 1200 WOODLAND HILLS, CA 91367 | KAISER FOUNDATION HEALTH PLAN INC | $23K | — | $23K | 4.99% |
| ACRISURE LLC3 Filed as: ORION RISK MANAGEMENT INSURANCE | 245 SOUTH LOS ROBLES AVENUE SUITE 400 PASADENA, CA 91101 | BLUE SHIELD OF CALIFORNIA | $16K | — | $16K | 4.12% |
| BENEFITS AMERICA INS. SVCS., LLC3 Filed as: BENEFITS AMERICA INS SVCS LLC | 6320 CANOGA AVENUE FLOOR 12 WOODLAND HILLS, CA 91367 | BLUE SHIELD OF CALIFORNIA | $1K | $240 | $1K | 0.36% |
| ACRISURE LLC3 Filed as: ORION RISK MANAGEMENT SERVICES INC | 1800 QUAIL STREET SUITE 110 NEWPORT BEACH, CA 92660 | PRINCIPAL LIFE INSURANCE COMPANY | $7K | — | $7K | 9.99% |
| BENEFITS AMERICA INSURANCE SER3 | 6320 CANOGA AVENUE 12TH FLOOR WOODLAND HILLS, CA 91367 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $62 | $1K | 15.75% |
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 78 | $833K |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 87 | $72K |
| Vision | BLUE SHIELD OF CALIFORNIA | 51 | $380K |
| Prescription drug | BLUE SHIELD OF CALIFORNIA | 51 | $380K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 49 | $8K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 87 | — |
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.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.