| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE WEST INSURANCE SERVICES | 3155 OLSEN DRIVE SAN JOSE, CA 95117 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $107K | — | $107K | 19.53% |
| ACRISURE LLC3 Filed as: ACRISURE WEST INSURANCE SERVICES | 3155 OLSEN DRIVE SAN JOSE, CA 95117 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $15K | $624 | $16K | 10.89% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | 100 OTTAWA AVENUE GRAND RAPIDS, MI 49503 | KAISER FOUNDATION HEALTH PLAN INC | $5K | — | $5K | 3.26% |
| FILICE INSURANCE AGENCY3 | 900 E HAMILTON AVE. CAMPBELL, CA 95008 | KAISER FOUNDATION HEALTH PLAN INC | $2K | — | $2K | 1.39% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | 100 OTTAWA AVENUE GRAND RAPIDS, MI 49503 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8K | $3K | $11K | 12.47% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | 100 OTTAWA AVENUE GRAND RAPIDS, MI 49503 | KAISER FOUNDATION HEALTH PLAN INC. | $899 | — | $899 | 2.60% |
| FILICE INSURANCE AGENCY3 | 900 E HAMILTON AVE. CAMPBELL, CA 95008 | KAISER FOUNDATION HEALTH PLAN INC. | $735 | — | $735 | 2.13% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | 100 OTTAWA AVENUE GRAND RAPIDS, MI 49503 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $424 | $2K | 18.12% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | 100 OTTAWA AVENUE GRAND RAPIDS, MI 49503 | UNUM INSURANCE COMPANY | $2K | $307 | $3K | 35.32% |
| GBS BENEFITS INC3 Filed as: GBS BENEFITS INC. | 2200 S. MAIN STREET SALT LAKE CITY, UT 84115 | UNUM INSURANCE COMPANY | $256 | $12 | $268 | 3.42% |
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 | 163 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 10 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 173 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 132 | $724K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 143 | $148K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 143 | $148K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 163 | $99K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 163 | $86K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 163 | $86K |
| Prescription drug(3 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 132 | $724K |
| Other(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 163 | $107K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 163 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.