| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 10531 4S COMMONS DR STE 166 516 SAN DIEGO, CA 92127 | BLUE CROSS OF CALIFORNIA | $83K | — | $83K | 5.60% |
| ALEXANDER BEDROSIAN3 | 480 31ST NE 4003 MIAMI, FL 33137 | BLUE CROSS OF CALIFORNIA | $18K | — | $18K | 1.25% |
| DOMINIC TOSCANELLI3 | 7 FILLMER AVE LOS GATOS, CA 95030 | BLUE CROSS OF CALIFORNIA | $18K | — | $18K | 1.25% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INSURANCE AND | FINANCIAL SERVICES 12404 PARK CENTRAL DR, SUITE 400S DALLAS, TX 75251 | BLUE CROSS OF CALIFORNIA | — | $9K | $9K | 0.59% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | PO BOX 7746 CITRUS HEIGHTS, CA 95621 | KAISER FOUNDATION HEALTH PLAN INC | $20K | — | $20K | 3.27% |
| ALEX BEDROSIAN3 | 224 11TH ST SAN FRANCISCO, CA 94103 | KAISER FOUNDATION HEALTH PLAN INC | $17K | — | $17K | 2.76% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | PO BOX 7746 CITRUS HEIGHTS, CA 95621 | KAISER FOUNDATION HEALTH PLAN INC | $3K | — | $3K | 0.50% |
| ALEX BEDROSIAN3 | 224 11TH ST SAN FRANCISCO, CA 94103 | KAISER FOUNDATION HEALTH PLAN INC | $7K | — | $7K | 4.83% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | PO BOX 7746 CITRUS HEIGHTS, CA 95621 | KAISER FOUNDATION HEALTH PLAN INC | $2K | — | $2K | 1.22% |
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 | 146 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 153 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 189 | $2.2M |
| Dental | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 259 | $233K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 259 | $233K |
| Life insurance | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 259 | $233K |
| Short-term disability | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 259 | $233K |
| Long-term disability | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 259 | $233K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 259 | — |
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.