| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INSURA | SERVICES, LLC 3155 OLSEN DRIVE SAN JOSE, CA 95117 | BLUE SHIELD OF CALIFORNIA | — | $83K | $83K | 5.29% |
| ACRISURE LLC3 Filed as: ACRISURE WEST INSURANCE SERVICES | 3155 OLSEN DR STE 400 SAN JOSE, CA 95117 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $1K | $6K | 6.72% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 100 STONY POINT RD STE 160 SANTA ROSA, CA 95401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 1.73% |
| ACRISURE LLC3 Filed as: ACRISURE WEST INSURANCE SERVICES | 3155 OLSEN DR STE 400 SAN JOSE, CA 95117 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $830 | $2K | 8.38% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 100 STONY POINT RD STE 160 SANTA ROSA, CA 95401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $461 | — | $461 | 1.72% |
| ACRISURE LLC3 Filed as: ACRISURE WEST INSURANCE SERVICES | 3155 OLSEN DR STE 400 SAN JOSE, CA 95117 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $647 | $2K | 8.55% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 100 STONY POINT RD STE 160 SANTA ROSA, CA 95401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $329 | — | $329 | 1.60% |
| ACRISURE LLC3 Filed as: ACRISURE WEST INSURANCE SERVICES | 3155 OLSEN DR STE 400 SAN JOSE, CA 95117 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $613 | $2K | 8.42% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 100 STONY POINT RD STE 160 SANTA ROSA, CA 95401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $337 | — | $337 | 1.74% |
| ACRISURE LLC3 Filed as: ACRISURE WEST INSURANCE SERVICES | 3155 OLSEN DR STE 400 SAN JOSE, CA 95117 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $493 | $2K | 10.45% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 100 STONY POINT RD STE 160 SANTA ROSA, CA 95401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $420 | — | $420 | 2.60% |
| ACRISURE LLC3 Filed as: ACRISURE WEST INSURANCE SERVICES | 3155 OLSEN DR STE 400 SAN JOSE, CA 95117 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $663 | $401 | $1K | 8.36% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 100 STONY POINT RD STE 160 SANTA ROSA, CA 95401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $228 | — | $228 | 1.79% |
| ACRISURE LLC3 Filed as: ACRISURE WEST INSURANCE SERVICES | 3155 OLSEN DR STE 400 SAN JOSE, CA 95117 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $346 | $2K | 17.34% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 100 STONY POINT RD STE 160 SANTA ROSA, CA 95401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $644 | — | $644 | 5.74% |
| ACRISURE LLC3 Filed as: ACRISURE WEST INSURANCE SERVICES | 3155 OLSEN DR STE 400 SAN JOSE, CA 95117 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $695 | $285 | $980 | 10.25% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 100 STONY POINT RD STE 160 SANTA ROSA, CA 95401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $260 | — | $260 | 2.72% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | 2700 ZANKER ROAD SUITE 150 SAN JOSE, CA 95134 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $446 | $316 | $762 | 17.07% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 STONY POINT RD STE 160 SANTA ROSA, CA 95401 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | — | $433 | $433 | 9.70% |
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 | 154 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 154 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE SHIELD OF CALIFORNIA | 237 | $1.6M |
| Dental(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 98 | $97K |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 140 | $19K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 153 | $33K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 153 | $27K |
| Prescription drug | BLUE SHIELD OF CALIFORNIA | 237 | $1.6M |
| Other(5 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 153 | $70K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 237 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.