| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC. | 39 MAIN ST TIBURON, CA 94920 | CALIFORNIA PHYSICIANS' SERVICE | $12K | $53K | $65K | 4.20% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | PO BOX 7746 CITRUS HEIGHTS, CA 95621 | KAISER FOUNDATION HEALTH PLAN INC | $46K | — | $46K | 5.87% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | PO BOX 7746 CITRUS HEIGHTS, CA 95621 | KAISER FOUNDATION HEALTH PLAN INC | $9K | — | $9K | 5.96% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | BLUE CROSS OF CALIFORNIA | $20K | — | $20K | 296.27% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INSURANCE AND | FINANCIAL SERVICES 12404 PARK CENTRAL DR, SUITE 400S DALLAS, TX 75251 | BLUE CROSS OF CALIFORNIA | — | $2K | $2K | 24.02% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC. | 39 MAIN ST TIBURON, CA 94920 | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | $437 | — | $437 | 7.54% |
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 | 122 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 126 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 135 | $2.5M |
| Dental | CALIFORNIA PHYSICIANS' SERVICE | 135 | $1.6M |
| Vision | CALIFORNIA PHYSICIANS' SERVICE | 135 | $1.6M |
| Life insurance(2 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 122 | $67K |
| Short-term disability | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 39 | $61K |
| Long-term disability | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 39 | $61K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 135 | $1.6M |
| Other | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | 122 | $6K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 135 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.