| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 10531 4S COMMONS DR STE 166 516 SAN DIEGO, CA 92127 | BLUE CROSS OF CALIFORNIA | $278K | — | $278K | 4.08% |
| HKSS SERVICES LLC3 | 3925 BOHANNON DRIVE SUITE 100 MENLO PARK, CA 94025 | BLUE CROSS OF CALIFORNIA | — | -$411 | -$411 | -0.01% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | KAISER FOUNDATION HEALTH PLAN INC | $22K | — | $22K | 3.47% |
| LEE SCHEUER3 | 3925 BOHANNON DR STE 100 MENLO PARK, CA 94025 | KAISER FOUNDATION HEALTH PLAN OF COLORADO | $5K | — | $5K | 2.91% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 2055 WOODSIDE RD STE 290 REDWOOD CITY, CA 94061 | VISION SERVICE PLAN | $2K | — | $2K | 3.07% |
| RHONA S UNSELL INC4 | 6525 GUNPARK DRIVE STE 370-152 BOULDER, CO 80301 | PRE-PAID SERVICE INC DBA LEGALSHIELD | $3K | — | $3K | 20.95% |
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 | 536 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 540 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 2,727 | $7.6M |
| Vision | VISION SERVICE PLAN | 413 | $71K |
| Life insurance | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 424 | $375K |
| Short-term disability | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 424 | $375K |
| Long-term disability | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 424 | $375K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 2,727 | $797K |
| Other | PRE-PAID SERVICE INC DBA LEGALSHIELD | 90 | $15K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,727 | — |
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.