| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR CALEDONIA, MI 49316 | CALIFORNIA PHYSICIANS' SERVICE | -$5K | $61K | $56K | 3.37% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9655 GRANITE RIDGE DRIVE SUITE 500 SAN DIEGO, CA 92123 | CALIFORNIA PHYSICIANS' SERVICE | — | $15K | $15K | 0.90% |
| CLAREMONT BUSINESS GROUP3 | 1000 BURNETT AVE SUITE 440 CONCORD, CA 94520 | CALIFORNIA PHYSICIANS' SERVICE | — | $1K | $1K | 0.08% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE STE 410 CAMPBELL, CA 95008 | KAISER FOUNDATION HEALTH PLAN INC | $46K | $2 | $46K | 4.68% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | DELTA DENTAL OF CALIFORNIA | $22K | — | $22K | 10.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE STE 410 CAMPBELL, CA 95008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $11K | $2K | $12K | 13.99% |
| BEERE & PURVES INC3 Filed as: BEERE & PURVES, INC. | 1350 TREAT BLVD STE 470 WALNUT CREEK, CA 94597 | VISION SERVICE PLAN | $1K | — | $1K | 4.71% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE STE 410 CAMPBELL, CA 95008 | VISION SERVICE PLAN | $1K | — | $1K | 4.42% |
| SUHR RISK SERVICES3 Filed as: SUHR RISK SERVICES OF CALIFORNIA | 5300 STEVENS CREEK BLVD 3RD FLOOR SAN JOSE, CA 95129 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | — | $50 | $50 | 0.16% |
| ACRISURE LLC3 Filed as: ACRISURE DBA SURH RISK SVCS OF CA | 5300 STEVENS CREEK BLVD 3RD FL SAN JOSE, CA 95129 | UNION SECURITY INSURANCE COMPANY | $2K | — | $2K | 16.20% |
| ACRISURE LLC3 Filed as: ACRISURE DBA SUHR RISK SVCS OF CA | 5300 STEVENS CREEK BLVD 3RD FL SAN JOSE, CA 95129 | UNION SECURITY INSURANCE COMPANY | $861 | — | $861 | 11.28% |
| ACRISURE LLC3 Filed as: ACRISURE DBA SUHR RISK SVCS OF CA | 5300 STEVENS CREEK BLVD 3RD FL SAN JOSE, CA 95129 | UNION SECURITY INSURANCE COMPANY | $455 | — | $455 | 11.39% |
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 | 141 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 141 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 161 | $2.7M |
| Dental | DELTA DENTAL OF CALIFORNIA | 292 | $224K |
| Vision | VISION SERVICE PLAN | 145 | $32K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 141 | $100K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 141 | $88K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 141 | $88K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 161 | $1.7M |
| Other(4 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 141 | $112K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 292 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.