| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA | 5664 PRAIRIE CREEK DRIVE CALEDONIA, MI 49316 | BLUE CROSS OF CALIFORNIA | $7K | — | $7K | 2.62% |
| VANTREO INSURANCE BROKERAGE3 | 100 STONY POINT ROAD, SUITE 160 SANTA ROSA, CA 95401 | BLUE CROSS OF CALIFORNIA | $3K | — | $3K | 1.02% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA | 5664 PRAIRIE CREEK DRIVE CALEDONIA, MI 49316 | KAISER FOUNDATION HEALTH PLAN INC. | $5K | — | $5K | 3.24% |
| VANTREO INSURANCE BROKERAGE3 | 100 STONY POINT ROAD, SUITE 160 SANTA ROSA, CA 95401 | KAISER FOUNDATION HEALTH PLAN INC. | $3K | — | $3K | 1.74% |
| AMWINS3 Filed as: LISI, INC. | 1600 W. HILLSDALE BLVD. SAN MATEO, CA 94402 | PREMIER ACCESS INSURANCE COMPANY | $4K | — | $4K | 4.97% |
| VANTREO INSURANCE BROKERAGE3 | 100 STONY POINT ROAD, SUITE 160 SANTA ROSA, CA 95401 | PREMIER ACCESS INSURANCE COMPANY | $2K | — | $2K | 2.31% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA | 5664 PRAIRIE CREEK DRIVE CALEDONIA, MI 49316 | PREMIER ACCESS INSURANCE COMPANY | $1K | — | $1K | 1.58% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA | 5664 PRAIRIE CREEK DRIVE CALEDONIA, MI 49316 | USAVISION, INC. | $1K | — | $1K | 8.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA | 5664 PRAIRIE CREEK DRIVE CALEDONIA, MI 49316 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $407 | $56 | $463 | 8.46% |
| VANTREO INSURANCE BROKERAGE3 | 100 STONY POINT ROAD, SUITE 160 SANTA ROSA, CA 95401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $140 | — | $140 | 2.56% |
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 | 121 | 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) | 123 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 44 | $423K |
| Dental | PREMIER ACCESS INSURANCE COMPANY | 89 | $83K |
| Vision | USAVISION, INC. | 76 | $14K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 121 | $5K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 44 | $423K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 121 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 121 | — |
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.