| 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 | — | $104K | $104K | 6.36% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | PO BOX 7746 CITRUS HEIGHTS, CA 95621 | KAISER FOUNDATION HEALTH PLAN INC | $34K | — | $34K | 5.93% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA | PO BOX 1788 GRAND RAPIDS, MI 49501 | STARMOUNT LIFE INSURANCE COMPANY | $14K | $3K | $17K | 13.19% |
| BENERATION LLC3 | GROUND FL 2124 RACE ST PHILADELPHIA, PA 19103 | STARMOUNT LIFE INSURANCE COMPANY | $3K | — | $3K | 1.97% |
| ACRISURE LLC3 | PO BOX 1788 GRAND RAPIDS, MI 49501 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8K | $2K | $9K | 13.23% |
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 | 142 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 142 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 237 | $2.2M |
| Dental | STARMOUNT LIFE INSURANCE COMPANY | 142 | $128K |
| Vision | STARMOUNT LIFE INSURANCE COMPANY | 142 | $128K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 148 | $71K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 148 | $71K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 148 | $71K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 237 | $1.6M |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 148 | $71K |
| 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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.