| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | CALIFORNIA PHYSICIANS' SERVICE | $27K | $7K | $33K | 4.97% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INS SVCS INC | 32110 AGOURA ROAD WESTALAKE VILLAGE, CA 91361 | CALIFORNIA PHYSICIANS' SERVICE | $13K | — | $13K | 2.00% |
| ACRISURE LLC3 | 2033 GATEWAY PL STE 150 SAN JOSE, CA 951103710 | KAISER FOUNDATION HEALTH PLAN INC | $9K | $4 | $9K | 3.73% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE, INC | 200 GALLERIA PKWY SE STE 1950 ATLANTA, GA 303395946 | KAISER FOUNDATION HEALTH PLAN INC | $385 | — | $385 | 0.15% |
| ACRISURE LLC3 | DBA PENTARISK INS SERVICES LLC 2033 GATEWAY PL STE 150 SAN JOSE, CA 95110 | PRINCIPAL LIFE INSURANCE COMPANY | $3K | — | $3K | 4.01% |
| DIGITAL INSURANCE LLC3 | 200 GALLERIA PKWY SE STE 1950 ATLANTA, GA 303395946 | PRINCIPAL LIFE INSURANCE COMPANY | — | $2K | $2K | 2.92% |
| ACRISURE LLC3 Filed as: ACRISURE INSURANCE AGENCY, LLC | 2033 GATEWAY PLACE SUITE 150 SAN JOSE, CA 95110 | HARTFORD LIFE AND ACCIDENT | $4K | — | $4K | 12.73% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 200 GALLERIA PKWY STE 1950 ATLANTA, GA 30339 | HARTFORD LIFE AND ACCIDENT | — | $561 | $561 | 1.74% |
| ACRISURE LLC3 Filed as: ACRISURE INSURANCE AGENCY, LLC | 6307 84TH ST SE CALEDONIA, MI 49316 | HARTFORD LIFE AND ACCIDENT | — | $348 | $348 | 1.08% |
| ACRISURE LLC3 | 2033 GATEWAY PL STE 150 SAN JOSE, CA 95110 | AFLAC | $3K | — | $3K | 20.24% |
| NICHOLAS J PISANO JR3 | 15781 CANON DR LOS GATOS, CA 95030 | AFLAC | $939 | — | $939 | 6.81% |
| GEORGE BERMUDES3 | 12896 JADE DR SALINAS, CA 93906 | AFLAC | $717 | — | $717 | 5.20% |
| JAYSON C ROCHA3 | 3279 SOUTHERLAND RD WEST SACRAMENTO, CA 95691 | AFLAC | $516 | — | $516 | 3.74% |
| KAMALA J COBURN3 | 934 LONGWOOD LN SAN JOSE, CA 95129 | AFLAC | $510 | — | $510 | 3.70% |
| GARY WAYNE OGLE3 | 134 D ST STE 202 EUREKA, CA 95501 | AFLAC | $312 | — | $312 | 2.26% |
| ZACHARY ALWEISS NIESEN3 | 35 UNDERHILL RD MILL VALLEY, CA 94941 | AFLAC | $274 | — | $274 | 1.99% |
| BYRON KINGSLEY JHA3 | 600 RAINBOW DR APT 229 MOUNTAIN VIEW, CA 94941 | AFLAC | $200 | — | $200 | 1.45% |
| SCOTLAND O MILLER3 | 217 VILLA GARDEN DR APT C MILL VALLEY, CA 94941 | AFLAC | $177 | — | $177 | 1.28% |
| JAYSON C ROCHA3 | 1372 LAFAYETTE ST SANTA CLARA, CA 95050 | AFLAC | $68 | — | $68 | 0.49% |
| DAVID B. KITCHEN3 Filed as: DAVID B KITCHEN | 1260 N DUTTON AVE STE 180 SANTA ROSA, CA 95401 | AFLAC | $41 | — | $41 | 0.30% |
| KRISTINA J KUNZ3 | 118 GRANVILLE WAY SAN FRANCISCO, CA 94127 | AFLAC | $28 | — | $28 | 0.20% |
| KRISTINA J KUNZ3 | 351 CALIFORNIA ST STE 450 SAN FRANCISCO, CA 94104 | AFLAC | $24 | — | $24 | 0.17% |
| ACRISURE LLC3 Filed as: PENTARISK IN DBA ACRISURE LLC | 2033 GATEWAY PLACE,STE 150 SAN JOSE, CA 95110 | CALIFORNIA DENTAL NETWORK, INC. | $504 | — | $504 | 10.01% |
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 | 123 | 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) | 123 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 127 | $920K |
| Dental(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 139 | $76K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 139 | $71K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 105 | $32K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 105 | $32K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 127 | $670K |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 105 | $46K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 139 | — |
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.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.