| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INTERNATIONAL PROINSURANCE SERVICES3 | 3905 BOHANNON DR #B MENLO PARK, CA 94025 | BLUE CROSS OF CALIFORNIA (G0200) | $129K | $21K | $150K | 2.19% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR CALEDONIA, MI 49316 | BLUE CROSS OF CALIFORNIA (G0200) | $61K | — | $61K | 0.89% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | KAISER FOUNDATION HEALTH PLAN INC | $42K | — | $42K | 3.20% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $35K | $16K | $51K | 7.27% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR CALEDONIA, MI 49316 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $5K | — | $5K | 10.00% |
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 | 775 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 775 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA (G0200) | 1,197 | $8.2M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 5 | $49K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 775 | $697K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 775 | $697K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 775 | $697K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 775 | $697K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 244 | $1.3M |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 775 | $746K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,197 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.