| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CA LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $61K | — | $61K | 13.02% |
| INTERNATIONAL PROINSURANCE SERVICES3 Filed as: INTERNATIONAL PROINSURANCE SVC LLC | 3925 BOHANNON DR #100 MENLO PARK, CA 94025 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $186 | — | $186 | 0.04% |
| ACRISURE LLC3 Filed as: ACRISURE OF CA LLC | 5664 PRAIRIE CREEK DR CALEDONIA, MI 49316 | KAISER FOUNDATION HEALTH PLAN INC | $14K | — | $14K | 3.40% |
| MARSH & MCLENNAN AGENCY LLC3 | 9171 TOWNE CENTRE DRIVE, SUITE 100 SAN DIEGO, CA 92122 | KAISER FOUNDATION HEALTH PLAN INC | $6K | — | $6K | 1.36% |
| ACRISURE LLC3 Filed as: ACRISURE OF CA LLC | 5664 PRAIRIE CREEK DR CALEDONIA, MI 49316 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $9K | — | $9K | 3.21% |
| MARSH & MCLENNAN AGENCY LLC3 | 9171 TOWNE CENTRE DRIVE, SUITE 100 SAN DIEGO, CA 92122 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $5K | — | $5K | 1.79% |
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 | 198 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 10 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 208 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 122 | $892K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 208 | $280K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 208 | $280K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 208 | $280K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 208 | $280K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 208 | $280K |
| Prescription drug(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 122 | $892K |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 208 | $280K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 208 | — |
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.