| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS. | 3155 OLSEN DRIVE, SUITE 400 SAN JOSE, CA 95117 | SUTTER HEALTH PLAN | $2K | $0 | $2K | 0.84% |
| USI INSURANCE SERVICES LLC3 | 575 MARKET STREET, SUITE 3750 SAN FRANCISCO, CA 94105 | WESTERN HEALTH ADVANTAGE | $7K | $0 | $7K | 3.67% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS W COAST INS. SVC. | 3155 OLSEN DRIVE, SUITE 100 SAN JOSE, CA 95117 | WESTERN HEALTH ADVANTAGE | $3K | $0 | $3K | 1.38% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $6K | $11K | 17.31% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS. | 3155 OLSEN DRIVE, SUITE 400 SAN JOSE, CA 95117 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 2.84% |
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 | 103 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 104 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | SUTTER HEALTH PLAN | 31 | $430K |
| Dental(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 113 | $63K |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 113 | $63K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 113 | $63K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 113 | $63K |
| Prescription drug(2 contracts, 2 carriers) | SUTTER HEALTH PLAN | 31 | $430K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 113 | $63K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 113 | — |
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.