| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR S CALEDONIA, MI 49316 | KAISER FOUNDATION HEALTH PLAN INC | $70K | — | $70K | 4.15% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INSURA | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | KAISER FOUNDATION HEALTH PLAN INC | $7K | $1 | $7K | 0.41% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | KAISER FOUNDATION HEALTH PLAN INC | $30K | — | $30K | 4.26% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INSURA | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | KAISER FOUNDATION HEALTH PLAN INC | $3K | — | $3K | 0.40% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA | 910 E HAMILTON AVE STE 410 CAMPBELL, CA 95008 | DELTA DENTAL OF CALIFORNIA | $5K | — | $5K | 3.05% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INSURA | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | DELTA DENTAL OF CALIFORNIA | $2K | — | $2K | 0.95% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | $991 | $8K | 17.11% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE STE 410 CAMPBELL, CA 95008 | DELTA DENTAL OF CALIFORNIA | $3K | — | $3K | 7.70% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INSURA | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | DELTA DENTAL OF CALIFORNIA | $1K | — | $1K | 2.29% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST I | ATTN ACCOUNTING ACRISURE WEST 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $821 | $4K | 9.32% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | ATTN ACCOUNTING ACRISURE WEST 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $737 | $6K | 17.14% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | INSURANCE SERVICES, LLC 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | VISION SERVICE PLAN | $924 | — | $924 | 3.14% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3155 OLSEN DR STE 400 SAN JOSE, CA 95117 | VISION SERVICE PLAN | $750 | — | $750 | 2.55% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INSURA | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | UNUM INSURANCE COMPANY | $2K | $787 | $3K | 14.33% |
| REMMEL SOLUTIONS4 | 1183 SWALLOWTAIL WAY NIPOMO, CA 93444 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $1K | — | $1K | 8.05% |
| ACRISURE LLC4 Filed as: ACRISURE OF CALIFORNIA LLC | 5300 STEVENS CREEK BLVD FL 3 SAN JOSE, CA 95159 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $846 | — | $846 | 6.23% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INSURA | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | UNUM INSURANCE COMPANY | $1K | $391 | $1K | 14.74% |
| 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 | $373 | — | $373 | 14.28% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | INSURANCE SERVICES 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $160 | $5 | $165 | 6.32% |
| 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 | $9 | — | $9 | — |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST | COAST INSURANCE SERVICES 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4 | — | $4 | — |
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 | 374 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 380 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | KAISER FOUNDATION HEALTH PLAN INC | 218 | $2.4M |
| Dental(2 contracts) | DELTA DENTAL OF CALIFORNIA | 258 | $211K |
| Vision | VISION SERVICE PLAN | 213 | $29K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 374 | $75K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 97 | $47K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 97 | $47K |
| Other(7 contracts, 4 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 374 | $125K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 374 | — |
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.