| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LUMITY, INC.3 Filed as: LUMITY INC. | 71 EAST 3RD AVEMUE SAN MATEO, CA 94401 | UNITEDHEALTHCARE INSURANCE COMPANY | $115K | $0 | $115K | 3.18% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | PO BOX 1788 GRAND RAPIDS, CA 49501 | UNITEDHEALTHCARE INSURANCE COMPANY | $57K | $0 | $57K | 1.56% |
| LUMITY, INC.3 Filed as: LUMITY INC. | 71 EAST 3RD AVEMUE SAN MATEO, CA 94401 | KAISER FOUNDATION HEALTH PLAN INC. | $34K | $0 | $34K | 2.43% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 EAST HAMILTON AVENUE, SUITE 410 CAMPBELL, CA 95008 | KAISER FOUNDATION HEALTH PLAN INC. | $22K | $0 | $22K | 1.57% |
| LUMITY, INC.3 Filed as: LUMITY INC. | 71 EAST 3RD AVEMUE SAN MATEO, CA 94401 | SUN LIFE ASSURANCE COMPANY OF CANADA | $18K | $0 | $18K | 11.89% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 EAST HAMILTON AVENUE, SUITE 410 CAMPBELL, CA 95008 | SUN LIFE ASSURANCE COMPANY OF CANADA | $11K | $0 | $11K | 7.60% |
| LUMITY, INC.3 Filed as: LUMITY INSURANCE SERVICES, INC. | 71 EAST 3RD AVEMUE SAN MATEO, CA 94401 | VISION SERVICE PLAN | $1K | $0 | $1K | 2.04% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 EAST HAMILTON AVENUE, SUITE 410 CAMPBELL, CA 95008 | VISION SERVICE PLAN | $192 | $0 | $192 | 0.31% |
| LUMITY, INC.3 Filed as: LUMITY INC. | 71 EAST 3RD AVEMUE SAN MATEO, CA 94401 | ANTHEM LIFE INSURANCE COMPANY | $2K | $0 | $2K | 5.83% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DRIVE CALEDONIA, MI 49316 | ANTHEM LIFE INSURANCE COMPANY | $1K | $0 | $1K | 4.16% |
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 | 542 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 11 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 553 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 916 | $5.0M |
| Dental | UNITEDHEALTHCARE INSURANCE COMPANY | 916 | $3.6M |
| Vision | VISION SERVICE PLAN | 338 | $62K |
| Life insurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 131 | $186K |
| Short-term disability(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 131 | $186K |
| Long-term disability(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 131 | $186K |
| Prescription drug(2 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 916 | $5.0M |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 131 | $186K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 916 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.