| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | PO BOX 1788 GRAND RAPIDS, MI 495011788 | UNITEDHEALTHCARE INSURANCE COMPANY | $181K | — | $181K | 3.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRARIE CREEK DR SE CALEDONIA, MI 49316 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $104K | — | $104K | 10.49% |
| SYNERGY ENROLLMENT AND BENEFITS LLC3 Filed as: SYNERGY ENROLLMENT & BENEFITS | 9370 SKY PARK COURT SUITE 250 SAN DIEGO, CA 92123 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $12K | — | $12K | 1.20% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA,LLC | — | SIMNSA | $29K | — | $29K | 7.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | DBA ELT INSURANCE SERVI 5664 PRAIRIE CREEK DRIVE CALEDONIA, MI 49316 | KAISER FOUNDATION HEALTH PLAN OF HAWAII | $2K | — | $2K | 3.05% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC DBA | ELT INSURANCE SERVI 5664 PRAIRIE CREEK DRIVE CALEDONIA, MI 49316 | KAISER FOUNDATION HEALTH PLAN OF HAWAII | $1K | — | $1K | 4.95% |
| ELT INSURANCE SERVICES3 | — | MONUMENTAL LIFE INSURANCE COMPANY | $1K | — | $1K | 6.15% |
| LEAVITT GROUP3 Filed as: SCOTT A LEAVITT | — | MONUMENTAL LIFE INSURANCE COMPANY | $297 | — | $297 | 1.48% |
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 | 1,038 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 9 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 36 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,083 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(6 contracts, 4 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 952 | $6.6M |
| Dental(3 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,053 | $1.4M |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,053 | $991K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,053 | $991K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,053 | $991K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,053 | $991K |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,053 | $991K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,053 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.