| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | DBA PROCO INSURANCE SERVICES 910 E. HAMILTON AVENUE CAMPBELL, CA 95008 | AETNA LIFE INSURANCE CO. | — | $3K | $3K | 0.12% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE STE 410 CAMPBELL, CA 95008 | METROPOLITAN LIFE INSURANCE COMPANY | $9K | — | $9K | 4.59% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRE CREEK DR SE CALEDONIA, MI 49316 | KAISER FOUNDATION HEALTH PLAN INC | $4K | — | $4K | 6.94% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5300 STEVENS CREEK BLVD SAN JOSE, CA 95129 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5K | $236 | $5K | 30.19% |
| DANIEL J BAZIS3 | 3190 OAK RD APT 310 WALNUT CREEK, CA 94597 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $3K | $5K | 29.45% |
| BRITTANY LLOYD3 | 6234 KINGS PEAK DR EL DORADO HILLS, CA 95762 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $2K | $5K | 26.84% |
| STEPHANIE NOELLE KUGLER3 | 21068 VALLEY CIR ELKHORN, NE 68022 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $696 | $469 | $1K | 6.76% |
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 | 102 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 108 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | AETNA LIFE INSURANCE CO. | 231 | $2.1M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 253 | $198K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 253 | $198K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 253 | $198K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 253 | $198K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 253 | $198K |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 253 | $215K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 253 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.