| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE 410 CAMPBELL, CA 95008 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $71K | — | $71K | 2.42% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES, INC. | 7701 AIRPORT CENTER DRIVE SUITE 1800 GREENSBORO, NC 27409 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $49K | — | $49K | 1.67% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 2055 WOODSIDE RD STE 290 REDWOOD CITY, CA 94061 | SUN LIFE ASSURANCE COMPANY OF CANADA | $6K | — | $6K | 2.42% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES, INC. | 214 N TRYON ST FL 46 CHARLOTTE, NC 28202 | SUN LIFE ASSURANCE COMPANY OF CANADA | $6K | — | $6K | 2.41% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | SUN LIFE ASSURANCE COMPANY OF CANADA | $426 | — | $426 | 0.18% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES, INC. | 3111 CAMINO DEL RIO N SUITE 1100 SAN DIEGO, CA 92108 | SUN LIFE ASSURANCE COMPANY OF CANADA | $385 | — | $385 | 0.16% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE 410 CAMPBELL, CA 95008 | HARTFORD LIFE AND ACCIDENT | $4K | — | $4K | 5.45% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES, INC. | PO BOX 896620 CHARLOTTE, NC 28289 | HARTFORD LIFE AND ACCIDENT | $3K | $442 | $4K | 5.18% |
| ACRISURE LLC3 | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | HARTFORD LIFE AND ACCIDENT | — | $1K | $1K | 1.79% |
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 | 401 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 403 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 450 | $2.9M |
| Dental | SUN LIFE ASSURANCE COMPANY OF CANADA | 260 | $238K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 450 | $2.9M |
| Life insurance(2 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 450 | $3.0M |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 66 | $70K |
| Other(2 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 450 | $3.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 450 | — |
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.