| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | CALIFORNIA PHYSICIANS SERVICE | — | $81 | $81 | 0.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $36K | $4K | $40K | 11.32% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DRIVE URBANDALE, IA 50323 | METROPOLITAN LIFE INSURANCE COMPANY | $6K | — | $6K | 4.58% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 OTTAWA AVE. GRAND RAPIDS, MI 49503 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $454 | $6K | 17.63% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DRIVE URBANDALE, IA 50323 | SAFEGUARD HEALTH PLANS, INC. | $459 | — | $459 | 4.58% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 OTTAWA AVE. GRAND RAPIDS, MI 49503 | UNUM INSURANCE COMPANY | $893 | $82 | $975 | 17.32% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 OTTAWA AVE. GRAND RAPIDS, MI 49503 | UNUM INSURANCE COMPANY | $266 | $43 | $309 | 11.59% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLENNAN AGENCY | 9171 TOWNE CENTRE DRIVE, SUITE 100 SAN DIEGO, CA 92122 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $34 | — | $34 | 2.32% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 OTTAWA AVE. GRAND RAPIDS, MI 49503 | UNUM INSURANCE COMPANY | $145 | $11 | $156 | 17.77% |
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 | 200 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 200 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA PHYSICIANS SERVICE | 138 | $2.3M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 256 | $132K |
| Vision | EYEMED VISION CARE | 116 | $18K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 200 | $389K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 200 | $355K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 200 | $355K |
| Prescription drug | CALIFORNIA PHYSICIANS SERVICE | 138 | $2.3M |
| Other(6 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 200 | $399K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 256 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.