| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | PO BOX 1788 GRAND RAPIDS, MI 49501 | AETNA LIFE INSURANCE CO. | $104K | $0 | $104K | 3.92% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | PO BOX 1788 GRAND RAPIDS, MI 49501 | AETNA HEALTH, INC. | $45K | $0 | $45K | 4.00% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INSURA | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | KAISER FOUNDATION HEALTH PLAN, INC. | $20K | $0 | $20K | 2.46% |
| PROGRESSIVE BENEFIT GROUP3 | 9035 SOQUEL AVE SUITE 200 SANTA CRUZ, CA 95062 | KAISER FOUNDATION HEALTH PLAN, INC. | $14K | $0 | $14K | 1.76% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INSURA | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | KAISER FOUNDATION HEALTH PLAN | $17K | $0 | $17K | 2.51% |
| PROGRESSIVE BENEFIT GROUP3 | 9035 SOQUEL AVE SUITE 200 SANTA CRUZ, CA 95062 | KAISER FOUNDATION HEALTH PLAN | $13K | $0 | $13K | 1.85% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $22K | $2K | $24K | 7.00% |
| ACRISURE LLC3 Filed as: ACRISURE WEST INSURANCE SERVICES LL | 900 E HAMILTON AVE STE 500 CAMPBELL, CA 95008 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $8K | $0 | $8K | 2.23% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INSURA | 100 OTTAWA AVE SW SUITE 200 GRAND RAPIDS, MI 49503 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $15K | $4K | $19K | 11.09% |
| ACRISURE LLC3 Filed as: ACRISURE OF CA LLC | 9035 SOQUEL AVE STE 200 SANTA CRUZ, CA 95062 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $9K | $4K | $12K | 23.47% |
| PACIFIC ADVISORS LLC3 | 2875 MICHELLE DR SUITE 110 IRVINE, CA 92606 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $172 | $0 | $172 | 0.32% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ACRISURE OF CALIFORNIA, LLC EIN 38-3942950 ADMINISTRATOR | Insurance agents and brokers Service code 22 | — | $0 |
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 | 393 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 393 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | AETNA LIFE INSURANCE CO. | 340 | $4.5M |
| Dental | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 340 | $343K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 340 | $343K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 393 | $172K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 393 | $172K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 393 | $172K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 393 | $225K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 393 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.