| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS | SERVICES LLC 3155 OLSEN DRIVE SAN JOSE, CA 95117 | CALIFORNIA PHYSICIANS' SERVICE | $42K | — | $42K | 3.56% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | INSURANCE SERVICES 3155 OLSEN DR, STE 400 SAN JOSE, CA 95117 | PRINCIPAL LIFE INSURANCE COMPANY | $16K | $7K | $23K | 15.09% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SVCS | ATTN ACCOUNTING DEPT. 32110 AGOURA RD WESTLAKE VILLAGE, CA 91361 | PRINCIPAL LIFE INSURANCE COMPANY | — | $4K | $4K | 2.44% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS | SERVICES 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | KAISER FOUNDATION HEALTH PLAN, INC. | $4K | — | $4K | 3.63% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 900 E HAMILTON AVE STE 500 CAMPBELL, CA 95008 | KAISER FOUNDATION HEALTH PLAN, INC. | $3K | — | $3K | 3.17% |
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 | 56 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 56 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 90 | $1.3M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 102 | $154K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 102 | $154K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 102 | $154K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 102 | $154K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 102 | $154K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 90 | $1.2M |
| Other | PRINCIPAL LIFE INSURANCE COMPANY | 102 | $154K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 102 | — |
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.