| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 34 SOUTH 2ND ST. CAMPBELL, CA 95008 | CALIFORNIA PHYSICIANS' SERVICE | $66K | — | $66K | 2.77% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E. HAMILTON AVE STE. 500 CAMPBELL, CA 95008 | CALIFORNIA PHYSICIANS' SERVICE | $65K | — | $65K | 2.74% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INS SVC | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | CALIFORNIA PHYSICIANS' SERVICE | — | $41K | $41K | 1.75% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | KAISER FOUNDATION HEALTH PLAN, INC. | $8K | — | $8K | 3.77% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SVCS INC. | 32110 AGOURA RD WESTLAKE VILLAGE, CA 91361 | KAISER FOUNDATION HEALTH PLAN, INC. | $4K | — | $4K | 1.72% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 900 E HAMILTON AVE STE 500 CAMPBELL, CA 95008 | KAISER FOUNDATION HEALTH PLAN, INC. | $2K | — | $2K | 1.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 34 SOUTH SECOND STREET CAMPBELL, CA 95008 | STARMOUNT LIFE INSURANCE COMPANY | $10K | $2K | $12K | 5.57% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E HAMILTON AVE STE 500 CAMPBELL, CA 95008 | STARMOUNT LIFE INSURANCE COMPANY | $10K | $2K | $12K | 5.42% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 34 SOUTH SECOND STREET CAMPBELL, CA 95008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $14K | $7K | $20K | 13.62% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 34 SOUTH SECOND STREET CAMPBELL, CA 95008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $1K | $5K | 20.56% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 34 SOUTH SECOND STREET CAMPBELL, CA 95008 | FIRST UNUM LIFE INSURANCE COMPANY | $264 | $82 | $346 | 19.68% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 34 SOUTH SECOND STREET CAMPBELL, CA 95008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $175 | $87 | $262 | 15.00% |
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 | 194 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 194 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 304 | $2.6M |
| Dental | STARMOUNT LIFE INSURANCE COMPANY | 170 | $212K |
| Vision | STARMOUNT LIFE INSURANCE COMPANY | 170 | $212K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 194 | $173K |
| Short-term disability(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 194 | $152K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 194 | $150K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 304 | $2.4M |
| Other(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 194 | $175K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 304 | — |
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.