| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | BLUE CROSS OF CALIFORNIA | $115K | — | $115K | 4.95% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | INC 32110 AGOURA RD WESTLAKE VILLAGE, CA 91361 | BLUE CROSS OF CALIFORNIA | — | $46K | $46K | 1.98% |
| ACRISURE LLC3 | 2033 GATEWAY PL STE 150 SAN JOSE, CA 951103710 | KAISER FOUNDATION HEALTH PLAN, INC. | $17K | — | $17K | 4.03% |
| ACRISURE LLC3 Filed as: ACRISURE LLC D/B/A PENTARISK | INSURANCE SERVICES LLC 2033 GATEWAY PL STE 150 SAN JOSE, CA 951103710 | METROPOLITAN LIFE INSURANCE COMPANY | $12K | — | $12K | 9.18% |
| PENTARISK3 | 2033 GATEWAY PLACE SUITE 150 SAN JOSE, CA 95110 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $16K | — | $16K | 15.00% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: BENEUSA LLC A WARNER PACIFIC | COMPANY 32110 AGOURA RD WESTLAKE VILLAGE, CA 91361 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | $2K | $5K | 5.00% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 2033 GATEWAY PL STE 150 SAN JOSE, CA 951103710 | VISION SERVICE PLAN | $2K | — | $2K | 4.68% |
| PENTARISK3 | 2033 GATEWAY PLACE SUITE 150 SAN JOSE, CA 95110 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | — | $5K | 15.00% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: BENEUSA LLC A WARNER PACIFIC | COMPANY 32110 AGOURA RD WESTLAKE VILLAGE, CA 91361 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 5.00% |
| PENTARISK3 | 2033 GATEWAY PLACE SUITE 150 SAN JOSE, CA 95110 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 15.00% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: BENEUSA LLC A WARNER PACIFIC | COMPANY 32110 AGOURA RD WESTLAKE VILLAGE, CA 91361 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $589 | $250 | $839 | 5.00% |
| PENTARISK3 | 2033 GATEWAY PLACE SUITE 150 SAN JOSE, CA 95110 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 15.00% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: BENEUSA LLC A WARNER PACIFIC | COMPANY 32110 AGOURA RD WESTLAKE VILLAGE, CA 91361 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $511 | — | $511 | 5.00% |
| PENTARISK3 | — | LIFE INSURANCE COMPANY OF NORTH AMERICA | $46 | — | $46 | 10.18% |
| ACRISURE LLC3 | — | LIFE INSURANCE COMPANY OF NORTH AMERICA | $22 | — | $22 | 4.87% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | — | LIFE INSURANCE COMPANY OF NORTH AMERICA | $14 | — | $14 | 3.10% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INS SERVIC | — | LIFE INSURANCE COMPANY OF NORTH AMERICA | $7 | — | $7 | 1.55% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: BENEUSA LLC A WARNER PACIFIC CO | — | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1 | — | $1 | 0.22% |
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 | 100 | 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) | 100 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 262 | $2.7M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 539 | $130K |
| Vision | VISION SERVICE PLAN | 132 | $35K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 139 | $109K |
| Short-term disability(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 139 | $11K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 139 | $32K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 139 | $17K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 539 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.