| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 5664 PRAIRIE CREEK DRIVE SE CALEDONIA, MI 49316 | KAISER FOUNDATION HEALTH PLAN INC | $63K | $0 | $63K | 4.52% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 100 STONY POINT ROAD SANTA ROSA, CA 95401 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $352 | $2K | 6.36% |
| ALAYNE MATA3 | 3276 KATHY WAY LOOMIS, CA 95650 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $0 | $2K | 4.60% |
| ANN MARIE BLEDSOE3 | PO BOX 951 WOODACRE, CA 94973 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $0 | $1K | 3.78% |
| DARRYL W VIDOR3 Filed as: DARRYL W. VIDOR | 3314 EUROPA STREET ROSEVILLE, CA 95661 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $292 | $0 | $292 | 0.87% |
| LAURA RUNYEON3 | 2042 WEATHERBY WAY PETALUMA, CA 94954 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $98 | $17 | $115 | 0.34% |
| JOSEPHINE EBALO BACCAY3 | 3812 AETNA SPRINGS WAY SACRAMENTO, CA 95834 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $17 | $45 | $62 | 0.18% |
| LUZ VICTORIA FERNANDEZ3 | 1500 HOBSON AVENUE WEST SACRAMENTO, CA 95605 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $24 | $0 | $24 | 0.07% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 1950 WEST CORPORATE WAY, SUITE 1 ANAHEIM, CA 92801 | AMERITAS LIFE INSURANCE CORPORATION | $2K | $142 | $2K | 10.84% |
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 | 103 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 103 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 211 | $1.4M |
| Vision | AMERITAS LIFE INSURANCE CORPORATION | 226 | $17K |
| Other | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 112 | $34K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 226 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.