| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE STE 410 CAMPBELL, CA 95008 | BLUE CROSS OF CALIFORNIA (G0200) | $228K | — | $228K | 2.40% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | KAISER FOUNDATION HEALTH PLAN INC | $49K | — | $49K | 3.38% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3 POLARIS WAY 4TH FLOOR ALISO VIEJO, CA 92656 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $33K | $43K | $76K | 10.15% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 504 REDWOOD BLVD SUITE 204 NOVATO, CA 94947 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $9K | — | $9K | 10.74% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 504 REDWOOD BLVD SUITE 240 NOVATO, CA 94947 | CHLIC FOR THE BENEFIT OF LINA | $2K | — | $2K | 10.39% |
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 | 815 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 10 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 825 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA (G0200) | 1,424 | $11.0M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 5 | $88K |
| Vision(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA (G0200) | 1,424 | $10.3M |
| Life insurance(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 815 | $771K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 815 | $753K |
| Long-term disability(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 815 | $771K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 248 | $1.5M |
| Other(5 contracts, 5 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,542 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,542 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.