| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE WEST INSURANCE SERVICES | LLC 900 EAST HAMILTON AVE, SUITE 500 CAMPBELL, CA 95008 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $94K | — | $94K | 1.97% |
| ACRISURE LLC3 | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | — | $8K | $8K | 0.17% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | INSURANCE SERVICES 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | KAISER FOUNDATION HEALTH PLAN INC | $35K | $1 | $35K | 1.64% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 900 E HAMILTON AVE STE 500 CAMPBELL, CA 95008 | KAISER FOUNDATION HEALTH PLAN INC | $22K | — | $22K | 1.03% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | INS SVC LLC PO BOX 1788 GRAND RAPIDS, MI 49501 | ANTHEM LIFE INSURANCE COMPANY | $29K | — | $29K | 10.92% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | INS SVC LLC PO BOX 1788 GRAND RAPIDS, MI 49501 | ANTHEM LIFE INSURANCE COMPANY | $9K | — | $9K | 10.86% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 1350 TREAT BLVD STE 100 WALNUT CREEK, CA 94597 | METROPOLITAN GENERAL INSURANCE COMPANY | $4K | — | $4K | 9.12% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 1150 MORAGA WAY MORAGA, CA 94556 | METROPOLITAN GENERAL INSURANCE COMPANY | $361 | — | $361 | 0.88% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | INS SVC LLC PO BOX 1788 GRAND RAPIDS, MI 49501 | ANTHEM LIFE INSURANCE COMPANY | $664 | — | $664 | 10.92% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 900 E HAMILTON AVE STE 500 CAMPBELL, CA 95008 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $161 | — | $161 | 9.99% |
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 | 535 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 12 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 547 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 1,028 | $6.9M |
| Dental | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 1,028 | $4.8M |
| Vision | VISION SERVICE PLAN | 514 | $95K |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 661 | $265K |
| Short-term disability | ANTHEM LIFE INSURANCE COMPANY | 30 | $6K |
| Long-term disability | ANTHEM LIFE INSURANCE COMPANY | 547 | $80K |
| Other(3 contracts, 3 carriers) | ANTHEM LIFE INSURANCE COMPANY | 661 | $308K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,028 | — |
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.