| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | KAISER FOUNDATION HEALTH PLAN INC | $25K | — | $25K | 5.48% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | KAISER FOUNDATION HEALTH PLAN INC | $9K | — | $9K | 4.95% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3925 BOHANNON DR STE 100 MENLO PARK, CA 94025 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $3K | $9K | 16.29% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3925 BOHANNON DR, STE 100 MENLO PARK, CA 94025 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $3K | $6K | 11.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3925 BOHANNON DR, STE 100 MENLO PARK, CA 94025 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $4K | $8K | 17.36% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA | 2055 WOODSIDE RD SUITE 290 REDWOOD CITY, CA 94061 | SUN LIFE ASSURANCE COMPANY OF CANADA | $4K | — | $4K | 14.94% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3925 BOHANNON DR, STE 100 MENLO PARK, CA 94025 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $2K | $4K | 16.27% |
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 | 264 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 267 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | KAISER FOUNDATION HEALTH PLAN INC | 53 | $645K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 260 | $103K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 259 | $26K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 259 | $55K |
| Prescription drug(2 contracts) | KAISER FOUNDATION HEALTH PLAN INC | 53 | $645K |
| Other(4 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 264 | $140K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 264 | — |
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.