| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | SUN LIFE ASSURANCE COMPANY OF CANADA | $31K | — | $31K | 3.87% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3110 E GUASTI RD STE 500 ONTARIO, CA 91761 | SUN LIFE ASSURANCE COMPANY OF CANADA | $31K | — | $31K | 3.78% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3110 E GUASTI RD STE 500 ONTARIO, CA 91761 | SUN LIFE ASSURANCE COMPANY OF CANADA | $49K | — | $49K | 8.91% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | SUN LIFE ASSURANCE COMPANY OF CANADA | $8K | — | $8K | 1.49% |
| BOK FINANCIAL INSURANCE3 Filed as: LEE, EDWARD BOK | 10531 4S COMMONS DR STE 166-516 SAN DIEGO, CA 92127 | SUN LIFE ASSURANCE COMPANY OF CANADA | $792 | — | $792 | 0.14% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 5664 PRAIRIE CREEK DRIVE SE CALEDONIA, MI 49316 | SIMNSA | $25K | — | $25K | 7.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC DBA | ELT INSURANCE SERVICES 5664 PRAIRIE CREEK DRIVE CALEDONIA, MI 49316 | KAISER FOUNDATION HEALTH PLAN OF HAWAII | $3K | — | $3K | 3.07% |
| ELT INSURANCE SERVICES3 | 16835 W BERNARDO DR SAN DIEGO, CA 92127 | HARTFORD ACCIDENT AND LIFE INSURANCE COMPANY | $2K | — | $2K | 9.37% |
| LEAVITT GROUP3 Filed as: SCOTT A. LEAVITT | — | HARTFORD ACCIDENT AND LIFE INSURANCE COMPANY | $145 | — | $145 | 0.89% |
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 | 1,113 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 12 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,125 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | SIMNSA | 142 | $469K |
| Dental(3 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 655 | $923K |
| Vision | SUN LIFE ASSURANCE COMPANY OF CANADA | 655 | $555K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,096 | $810K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,096 | $810K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,096 | $810K |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,096 | $810K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,096 | — |
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.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.