| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INNOVATIVE COST MANAGEMENT SERVICES3 Filed as: INNOVATIVE COST MANAGEMENT | 95 S. MARKET STREET, SUITE 600 SAN JOSE, CA 95113 | CALIFORNIA PHYSICIANS' SERVICE (BLUE SHIELD OF CALIFORNIA) | $36K | — | $36K | 5.82% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WORD & BROWN | 701 S. PARKER STEET, 8TH FLOOR ORANGE, CA 92868 | CALIFORNIA PHYSICIANS' SERVICE (BLUE SHIELD OF CALIFORNIA) | $3K | — | $3K | 0.49% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5300 STEVEN CREEK BLVD., FLOOR 3 SAN JOSE, CA 95129 | CALIFORNIA PHYSICIANS' SERVICE (BLUE SHIELD OF CALIFORNIA) | -$29K | — | -$29K | -4.61% |
| INNOVATIVE COST MANAGEMENT SERVICES3 Filed as: INNOVATIVE COST MANAGEMENT | 95 S. MARKET STREET, SUITE 600 SAN JOSE, CA 95113 | KAISER FOUNDATION HEALTH PLAN INC. | $4K | — | $4K | 4.78% |
| ROBERT B. SUHR & COMPANY3 Filed as: ROBERT B. SUHR & CO. INS. BROKERS | 5300 STEVENS CREEK BLVD. SAN JOSE, CA 95129 | KAISER FOUNDATION HEALTH PLAN INC. | -$173 | — | -$173 | -0.20% |
| INNOVATIVE COST MANAGEMENT SERVICES3 Filed as: INNOVATIVE COST MANAGEMENT | 95 S. MARKET STREET, SUITE 600 SAN JOSE, CA 95113 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $337 | — | $337 | 10.00% |
| INNOVATIVE COST MANAGEMENT SERVICES3 Filed as: INNOVATIVE COST MANAGEMENT | 95 S. MARKET STREET, SUITE 600 SAN JOSE, CA 95113 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $464 | — | $464 | 15.01% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5300 STEVENS CREEK BLVD., SUITE 300 SAN JOSE, CA 95129 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $341 | — | $341 | 14.99% |
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 | 126 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 127 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE (BLUE SHIELD OF CALIFORNIA) | 109 | $708K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 126 | $6K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE (BLUE SHIELD OF CALIFORNIA) | 109 | $708K |
| Other(3 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 126 | $9K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 126 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.