| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | 3155 OLSEN DRIVE SAN JOSE, CA 95117 | CALIFORNIA PHYSICIANS SERVICE (BLUE SHIELD OF CALIFORNIA) | — | $53K | $53K | 2.88% |
| GBS BENEFITS INC3 Filed as: GBS BENEFITS INC. | 2200 S. MAIN STREET SALT LAKE CITY, UT 84115 | CALIFORNIA PHYSICIANS SERVICE (BLUE SHIELD OF CALIFORNIA) | — | $44K | $44K | 2.39% |
| FILICE INSURANCE AGENCY3 | 900 E HAMILTON AVE. CAMPBELL, CA 95008 | KAISER FOUNDATION HEALTH PLAN INC | $4K | — | $4K | 2.74% |
| GBS BENEFITS INC3 Filed as: GBS BENEFITS INC. | 2200 S. MAIN STREET SALT LAKE CITY, UT 84115 | KAISER FOUNDATION HEALTH PLAN INC | $4K | — | $4K | 2.40% |
| GBS BENEFITS INC3 Filed as: GBS BENEFITS INC. | 2200 S. MAIN STREET SALT LAKE CITY, UT 84115 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $6K | $2K | $8K | 5.87% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST | 3155 OLSEN DRIVE SAN JOSE, CA 95117 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $8K | — | $8K | 5.81% |
| GBS BENEFITS INC3 Filed as: GBS BENEFITS INC. | 2200 S. MAIN STREET SALT LAKE CITY, UT 84115 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $910 | $6K | 7.40% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST | 3155 OLSEN DRIVE SAN JOSE, CA 95117 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $2K | $6K | 6.93% |
| GBS BENEFITS INC3 Filed as: GBS BENEFITS INC. | 2200 S. MAIN STREET SALT LAKE CITY, UT 84115 | KAISER FOUNDATION HEALTH PLAN INC. | $663 | — | $663 | 3.76% |
| FILICE INSURANCE AGENCY3 | 900 E HAMILTON AVE. CAMPBELL, CA 95008 | KAISER FOUNDATION HEALTH PLAN INC. | $441 | — | $441 | 2.50% |
| GBS BENEFITS INC3 Filed as: GBS BENEFITS INC. | 2200 S. MAIN STREET SALT LAKE CITY, UT 84115 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $868 | $111 | $979 | 10.49% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST | 3155 OLSEN DRIVE SAN JOSE, CA 95117 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $732 | $244 | $976 | 10.46% |
| GBS BENEFITS INC3 Filed as: GBS BENEFITS INC. | 2200 S. MAIN STREET SALT LAKE CITY, UT 84115 | UNUM INSURANCE COMPANY | $3K | $137 | $3K | 55.87% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST | 3155 OLSEN DRIVE SAN JOSE, CA 95117 | UNUM INSURANCE COMPANY | $88 | $8 | $96 | 1.70% |
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 | 174 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 176 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE (BLUE SHIELD OF CALIFORNIA) | 134 | $2.0M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 145 | $139K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 145 | $139K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 174 | $89K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 174 | $80K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 174 | $80K |
| Prescription drug(3 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE (BLUE SHIELD OF CALIFORNIA) | 134 | $2.0M |
| Other(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 174 | $95K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 174 | — |
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.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.