| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS | SERVICES 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | KAISER FOUNDATION HEALTH PLAN, INC. | $24K | — | $24K | 2.68% |
| ACRISURE LLC3 | 1950 W CORPORATE WAY STE 23968 ANAHEIM, CA 92801 | KAISER FOUNDATION HEALTH PLAN, INC. | $23K | — | $23K | 2.65% |
| JINDRICH & ASSOCIATES INS AGENCY3 | 3205 WASATCH RD PLACERVILLE, CA 95667 | KAISER FOUNDATION HEALTH PLAN, INC. | -$3K | — | -$3K | -0.36% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INSURA | 3155 OLSEN DR STE 400 SAN JOSE, CA 95117 | SUTTER HEALTH PLAN | $13K | — | $13K | 5.00% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SRVCS INC | 2677 N MAIN ST STE 800 SANTA ANA, CA 92705 | SUTTER HEALTH PLAN | $5K | — | $5K | 2.00% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 1350 TREAT BLVD STE 100 WALNUT CREEK, CA 94597 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | — | $5K | 4.52% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS | SERVICES LLC 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | METROPOLITAN LIFE INSURANCE COMPANY | $345 | $101 | $446 | 0.41% |
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 | 204 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 204 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 157 | $1.1M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 204 | $108K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 204 | $108K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 204 | $108K |
| Prescription drug | SUTTER HEALTH PLAN | 53 | $265K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 204 | $108K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 204 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.