| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | KAISER FOUNDATION HEALTH PLAN INC | $44K | — | $44K | 3.37% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE STE 410 CAMPBELL, CA 95008 | KAISER FOUNDATION HEALTH PLAN INC | $21K | — | $21K | 1.59% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | KAISER FOUNDATION HEALTH PLAN INC | $19K | — | $19K | 3.08% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE STE 410 CAMPBELL, CA 95008 | KAISER FOUNDATION HEALTH PLAN INC | $9K | — | $9K | 1.46% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | PO BOX 1788 GRAND RAPIDS, MI 49501 | UNITEDHEALTHCARE INSURANCE COMPANY | $25K | — | $25K | 4.59% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA | 910 E HAMILTON AVE STE 410 CAMPBELL, CA 95008 | DELTA DENTAL OF CALIFORNIA | $5K | — | $5K | 4.19% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 910 E HAMILTON AVE STE 410 CAMPBELL, CA 95008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8K | $1K | $9K | 17.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE STE 410 CAMPBELL, CA 95008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $848 | $7K | 17.06% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE STE 410 CAMPBELL, CA 95008 | DELTA DENTAL OF CALIFORNIA | $4K | — | $4K | 10.59% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE, STE 410 CAMPBELL, CA 95008 | VISION SERVICE PLAN | $1K | — | $1K | 4.28% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE STE 410 CAMPBELL, CA 95008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $586 | $3K | 10.25% |
| SYNERGY ENROLLMENT AND BENEFITS LLC3 Filed as: SYNERGY ENROLLMENT AND BENEFITS, LL | 9370 SKY PARK CT SUITE 250 SAN DIEGO, CA 92123 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $118 | $2K | 11.42% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | PO BOX 1788 GRAND RAPIDS, MI 49501 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $631 | $14 | $645 | 3.25% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, | LLC DBA PROCO INSURANCE SE 910 E HAMILTON AVE, STE 410 CAMPBELL, CA 95008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $289 | $16 | $305 | 1.54% |
| SYNERGY ENROLLMENT AND BENEFITS LLC3 Filed as: SYNERGY ENROLLMENT AND BENEFITS, LL | 9370 SKY PARK CT SUITE 250 SAN DIEGO, CA 92123 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $57 | $1K | 30.30% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | DBA PROCO INSURANCE SE 910 E HAMILTON AVE, STE 410 CAMPBELL, CA 95008 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $436 | $14 | $450 | 12.69% |
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 | 340 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 341 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 233 | $2.5M |
| Dental(2 contracts) | DELTA DENTAL OF CALIFORNIA | 217 | $166K |
| Vision | VISION SERVICE PLAN | 258 | $31K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 314 | $71K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 68 | $55K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 68 | $55K |
| Other(6 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 314 | $96K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 314 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.