| 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 | $26K | — | $26K | 2.33% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA DBA PROCO | INSURANCE SERVICES 3925 BOHANNON DRIVE, SUITE 100 MENLO PARK, CA 94025 | AETNA LIFE INSURANCE CO. | $19K | — | $19K | 4.97% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS FINANCIAL SER | 12404 PARK CENTRAL DR. SUITE 400 DALLAS, TX 75251 | AETNA LIFE INSURANCE CO. | $9K | — | $9K | 2.49% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC DBA | PROCO INS SVCE 3925 BOHANNON DR., STE 100 MENLO PARK, CA 94025 | VISION SERVICE PLAN | $2K | — | $2K | 2.82% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3925 BOHANNON DR, STE 100 MENLO PARK, CA 94025 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $8K | — | $8K | 15.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3925 BOHANNON DR., STE 100 MENLO PARK, CA 94025 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $4K | — | $4K | 15.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3925 BOHANNON DR STE 100 MENLO PARK, CA 94025 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $3K | — | $3K | 15.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3925 BOHANNON DR STE 100 MENLO PARK, CA 94025 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $3K | — | $3K | 15.00% |
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 | 333 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 336 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 242 | $1.1M |
| Dental | AETNA LIFE INSURANCE CO. | 651 | $373K |
| Vision | VISION SERVICE PLAN | 300 | $77K |
| Life insurance(2 contracts) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 328 | $69K |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 328 | $21K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 328 | $27K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 242 | $1.1M |
| Other(2 contracts) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 328 | $69K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 651 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.