| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR CALEDONIA, MI 49316 | BLUE CROSS OF CALIFORNIA (G0200) | $184K | $6K | $190K | 2.75% |
| INTERNATIONAL PROINSURANCE SERVICES3 | 3905 BOHANNON DR #B MENLO PARK, CA 94025 | BLUE CROSS OF CALIFORNIA (G0200) | -$390 | — | -$390 | -0.01% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | KAISER FOUNDATION HEALTH PLAN INC | $47K | — | $47K | 3.49% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $33K | $14K | $47K | 6.87% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR CALEDONIA, MI 49316 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $8K | — | $8K | 9.22% |
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 | 702 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 702 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA (G0200) | 1,133 | $8.3M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 5 | $85K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 702 | $685K |
| Life insurance(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 702 | $771K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 702 | $685K |
| Long-term disability(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 702 | $771K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 240 | $1.4M |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 702 | $771K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,133 | — |
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.