| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RANDOLFPH A ELDER3 | 621 S WALNUT STREET STE F LOOMIS, CA 95650 | BLUE SHIELD OF CALIFORNIA | $70K | — | $70K | 3.60% |
| CLAREMONT BUSINESS GROUP3 | 1000 BURNETT AVE STE 440 CONCORD, CA 94520 | BLUE SHIELD OF CALIFORNIA | $39K | — | $39K | 2.00% |
| ACRISURE LLC3 Filed as: ARISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DRIVE CALEDONIA, MI 49316 | BLUE SHIELD OF CALIFORNIA | $27K | — | $27K | 1.40% |
| RANDOLPH ELDER3 | PO BOX 2150 LOOMIS, CA 95650 | KAISER FOUNDATION HEALTH PLAN INC | $15K | — | $15K | 3.61% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5300 STEVENS CREEK BLVD FLOOR 3 SAN JOSE, CA 95129 | KAISER FOUNDATION HEALTH PLAN INC | $4K | — | $4K | 0.88% |
| ROBERT B. SUHR & COMPANY3 Filed as: ROBERT B SUHR & COMPANY | INSURANCE BROKERS, INC. 5300 STEVENS CREEK BLVD SAN JOSE, CA 95129 | KAISER FOUNDATION HEALTH PLAN INC | $2K | — | $2K | 0.43% |
| RALPH ELDER3 | PO BOX 2150 LOOMIS, CA 95650 | METROPOLITAN LIFE INSURANCE COMPANY | $31K | $3K | $34K | 8.96% |
| CLAREMONT BUSINESS GROUP3 Filed as: CLAREMONT BUSINESS GROUP INC | 1000 BURNETT AVE STE 440 CONCORD, CA 94520 | METROPOLITAN LIFE INSURANCE COMPANY | $19K | — | $19K | 4.93% |
| SUHR RISK SERVICES3 Filed as: SUHR RISK SERVICES OF CALIFORNIA | 5300 STEVENS CREEK BLVD THIRD FLOOR SAN JOSE, CA 95129 | METROPOLITAN LIFE INSURANCE COMPANY | $7K | — | $7K | 1.78% |
| RANDOLPH ELDER3 | PO BOX 2150 LOOMIS, CA 95650 | KAISER FOUNDATION HEALTH PLAN INC | $10K | — | $10K | 3.67% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5300 STEVENS CREEK BLVD FLOOR 3 SAN JOSE, CA 95129 | KAISER FOUNDATION HEALTH PLAN INC | $2K | — | $2K | 0.83% |
| ROBERT B. SUHR & COMPANY3 | INSURANCE BROKERS, INC 5300 STEVENS CREEK BLVD SAN JOSE, CA 95129 | KAISER FOUNDATION HEALTH PLAN INC | $1K | — | $1K | 0.41% |
| RANDOLP ELDER3 | PO BOX 2150 LOOMIS, CA 95650 | VISION SERVICE PLAN | $1K | — | $1K | 4.08% |
| ACRISURE LLC3 Filed as: ACRISURE OF CA LLC | 5300 STEVENS CREEK BLVD THIRD FLOOR SAN JOSE, CA 95129 | VISION SERVICE PLAN | $218 | — | $218 | 0.82% |
| RANDOLPH ELDER3 | PO BOX 2150 LOOMIS, CA 95650 | SAFEGUARD HEALTH PLANS INC | $86 | — | $86 | 6.53% |
| CLAREMONT BUSINESS GROUP3 Filed as: CLAREMONT BUSINESS GROUP INC | 1000 BURNETT AVE STE 440 CONCORD, CA 94520 | SAFEGUARD HEALTH PLANS INC | $64 | — | $64 | 4.86% |
| SUHR RISK SERVICES3 Filed as: SUHR RISK SERVICES OF CALIFORNIA | 5300 STEVENS CREEK BLVD SAN JOSE, CA 95129 | SAFEGUARD HEALTH PLANS INC | $42 | — | $42 | 3.19% |
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 | 221 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 225 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | BLUE SHIELD OF CALIFORNIA | 254 | $2.6M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 675 | $386K |
| Vision | VISION SERVICE PLAN | 210 | $27K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 675 | $385K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 675 | $385K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 675 | $385K |
| Prescription drug(3 contracts, 2 carriers) | BLUE SHIELD OF CALIFORNIA | 254 | $2.6M |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 675 | $385K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 675 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.