| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 770 KENMOOR AVE SE SUITE 300 GRAND RAPIDS, MI 49546 | KAISER FOUNDATION HEALTH PLAN INC | $107K | — | $107K | 2.75% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | PO BOX 1788 GRAND RAPIDS, MI 49501 | STANDARD INSURANCE COMPANY | $25K | — | $25K | 4.92% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | PO BOX 1788 GRAND RAPIDS, MI 49501 | STANDARD INSURANCE COMPANY | $3K | — | $3K | 0.53% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | PO BOX 1788 GRAND RAPIDS, MI 49501 | STANDARD INSURANCE COMPANY | $20K | — | $20K | 4.87% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3925 BOHANNON DRIVE, SUITE 100 MENLO PARK, CA 94025 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $12K | — | $12K | 3.04% |
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 | 2,682 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 15 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 28 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,725 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 711 | $4.3M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 102 | $406K |
| Life insurance | STANDARD INSURANCE COMPANY | 2,682 | $513K |
| Long-term disability | STANDARD INSURANCE COMPANY | 2,241 | $407K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 711 | $3.9M |
| Other(2 contracts, 2 carriers) | MODERN HEALTH INC | 5,751 | $447K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 5,751 | — |
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.