| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9655 GRANITE RIDGE DRIVE, SUITE 500 SAN DIEGO, CA 92123 | CALIFORNIA PHYSICIANS' SERVICE | $7 | $59K | $59K | 5.32% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR. CALDEDONIA, MI 49316 | KAISER FOUNDATION HEALTH PLAN INC | $16K | — | $16K | 5.63% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA | DBA AHERN-ELT INS SERVICES LLC 9655 GRANITE RIDGE DR STE 500 SAN DIEGO, CA 92123 | PRINCIPAL LIFE INSURANCE COMPANY | $33K | — | $33K | 12.53% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR. GLASER WEIL FINK HO, MI 49316 | KAISER FOUNDATION HEALTH PLAN INC | $13K | — | $13K | 5.54% |
| GROUP BENEFIT OPTIONS3 | 2 CORPORATE DRIVE SUITE 636 SHELTON, CT 06484 | ZURICH AMERICAN INSURANCE COMPANY | $1K | — | $1K | 22.95% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 9655 GRANITE RIDGE DRIVE SUITE 500 SAN DIEGO, CA 92123 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $77 | $2K | — |
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 | 130 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 130 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 135 | $1.6M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 255 | $263K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 255 | $263K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 255 | $263K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 255 | $263K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 255 | $263K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 135 | $1.1M |
| Other(2 contracts, 2 carriers) | ZURICH AMERICAN INSURANCE COMPANY | 143 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 255 | — |
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.