| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 100 OTTAWA AVENUE SW GRAND RAPIDS, MI 49503 | BLUE CROSS OF CALIFORNIA | $210K | $0 | $210K | 2.11% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 323 WEST LAKESIDE AVENUE SUITE 410 CLEVELAND, OH 44113 | BLUE CROSS OF CALIFORNIA | $42K | $0 | $42K | 0.42% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 5664 PRAIRIE CREEK DRIVE SE CALEDONIA, CA 49316 | KAISER FOUNDATION HEALTH PLAN INC | $34K | $0 | $34K | 2.71% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES, INC. | 500 NORTH BRAND BOULEVARD SUITE 100 GLENDALE, CA 91203 | KAISER FOUNDATION HEALTH PLAN INC | $7K | $0 | $7K | 0.57% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 3 POLARIS WAY, 4TH FLOOR ALISO VIEJO, CA 92656 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $34K | $17K | $51K | 6.80% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 333 EAST OSBORN ROAD, SUITE 270 PHOENIX, AZ 85012 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $5K | $0 | $5K | 0.62% |
| INTERNATIONAL PROINSURANCE SERVICES3 | UNKNOWN REDWOOD CITY, CA 94065 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $9K | $0 | $9K | 15.05% |
| INTERNATIONAL PROINSURANCE SERVICES3 | UNKNOWN REDWOOD CITY, CA 94065 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | $0 | $3K | 14.71% |
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 | 629 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 16 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 645 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 1,220 | $11.3M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 2 | $60K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 720 | $751K |
| Life insurance(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 720 | $771K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 720 | $751K |
| Long-term disability(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 720 | $771K |
| Prescription drug(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 1,220 | $11.3M |
| Other(4 contracts, 4 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,659 | $976K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,659 | — |
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."
No prospect flags tripped on this filing.