| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS | SERVICES 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | KAISER FOUNDATION HEALTH PLAN INC | $7K | — | $7K | 3.35% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | KAISER FOUNDATION HEALTH PLAN INC | $3K | — | $3K | 1.38% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS | SERVICES 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | KAISER FOUNDATION HEALTH PLAN INC | $4K | — | $4K | 3.80% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | KAISER FOUNDATION HEALTH PLAN INC | $2K | — | $2K | 1.56% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9140 E HAMILTON AVE STE 410 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $2K | $6K | 14.03% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9140 E HAMILTON AVE #410 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $1K | $3K | 9.02% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9140 E HAMILTON AVE #410 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $758 | $3K | 13.98% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9140 E HAMILTON AVE #410 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $938 | $3K | 15.34% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | INSURANCE SERVICES LLC 3155 OLSEN DR, SUITE 400 SAN JOSE, CA 95117 | SUN LIFE ASSURANCE COMPANY OF CANADA | $733 | — | $733 | 14.39% |
| ACRISURE LLC3 | 1460 US HIGHWAY 9 N SUITE 307 WOODBRIDGE, NJ 07095 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $70 | $70 | 1.37% |
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 | 140 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 140 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | KAISER FOUNDATION HEALTH PLAN INC | 13 | $306K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 127 | $55K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 140 | $19K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 127 | $43K |
| Prescription drug(2 contracts) | KAISER FOUNDATION HEALTH PLAN INC | 13 | $306K |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 127 | $60K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 140 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.