| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | KAISER FOUNDATION HEALTH PLAN INC | $18K | — | $18K | 4.38% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | INSURANCE SERVICES LLC 3155 OLSEN DR, SUITE 400 SAN JOSE, CA 95117 | SUN LIFE ASSURANCE COMPANY OF CANADA | $5K | — | $5K | 3.04% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 2055 WOODSIDE RD STE 290 REDWOOD CITY, CA 94061 | SUN LIFE ASSURANCE COMPANY OF CANADA | $3K | — | $3K | 2.06% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE, STE 410 CAMPBELL, CA 95008 | CIGNA | $6K | — | $6K | 4.51% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST | 3155 OLSEN DRIVE, SUITE 400 SAN JOSE, CA 95117 | CIGNA | $615 | — | $615 | 0.43% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | KAISER FOUNDATION HEALTH PLAN, INC. | $2K | — | $2K | 10.61% |
| ITG WORLDWIDE INSURANCE AGENCY3 Filed as: ITG WORLDWIDE INS AGENCY INC | SCOTT MARAS 6600 UNIVERSITY AVE DES MOINES, IA 50324 | UNITEDHEALTHCARE INSURANCE COMPANY | $585 | — | $585 | 14.06% |
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 | 216 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 219 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | KAISER FOUNDATION HEALTH PLAN INC | 58 | $426K |
| Dental(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 216 | $301K |
| Vision | SUN LIFE ASSURANCE COMPANY OF CANADA | 216 | $157K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 216 | $157K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 216 | $157K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 216 | $157K |
| Other(5 contracts, 5 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 290 | $189K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 290 | — |
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."
No prospect flags tripped on this filing.