| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | BLUE SHIED OF CALIFORNIA | $62 | $30K | $30K | 4.17% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INS SVCS INC | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | BLUE SHIED OF CALIFORNIA | — | $15K | $15K | 2.08% |
| ACRISURE LLC3 | 2033 GATEWAY PL STE 150 SAN JOSE, CA 951103710 | KAISER FOUNDATION HEALTH PLAN INC | $9K | $6 | $9K | 4.07% |
| ACRISURE LLC3 | ACRISURE LLC CALEDONIA, MI 49316 | MONY LIFE INSURANCE COMPANY OF AMERICA | $16K | — | $16K | 20.00% |
| ACRISURE LLC3 | 2033 GATEWAY PL STE 150 SAN JOSE, CA 95110 | AFLAC | $3K | — | $3K | 11.53% |
| NICHOLAS J PISANO JR3 | 15781 CANON DR LOS GATOS, CA 95030 | AFLAC | $992 | $181 | $1K | 5.35% |
| WILLIAM K VERBRUGGE3 | 27 CRYSTAL SPRINGS RD APT 6 SAN MATEO, CA 94402 | AFLAC | $483 | — | $483 | 2.20% |
| GEORGE BERMUDES3 | 12896 JADE DR SALINAS, CA 93906 | AFLAC | $216 | $170 | $386 | 1.76% |
| SLR INSURANCE SOLUTIONS INC3 Filed as: SLR INSURANCE SOLUTIONS | 3779 PEARL AVE SAN JOSE, CA 95136 | AFLAC | $330 | — | $330 | 1.50% |
| DERREK LYN KECK3 | 17809 COUNTRYSIDE CT SALINAS, CA 93907 | AFLAC | $252 | — | $252 | 1.15% |
| JAYSON C ROCHA3 | 3279 SOUTHERLAND RD WEST SACRAMENTO, CA 95691 | AFLAC | $203 | $42 | $245 | 1.12% |
| JULIANA L GOSCHY-STALIONS3 | 347 LOS PINOS WAY SAN JOSE, CA 95123 | AFLAC | $229 | — | $229 | 1.04% |
| KAMALA J COBURN3 | 934 LONGWOOD LN SAN JOSE, CA 95129 | AFLAC | $158 | $70 | $228 | 1.04% |
| DANNY J LEON3 | 6096 INDIAN AVE SAN JOSE, CA 95123 | AFLAC | $212 | — | $212 | 0.97% |
| SLR INSURANCE SOLUTIONS INC3 Filed as: SLR INSURANCE SOLUTIONS | 1021 TORRY CT ST JOHNS, FL 32259 | AFLAC | $205 | — | $205 | 0.93% |
| GARY WAYNE OGLE3 | 134 D ST STE 202 EUREKA, CA 95501 | AFLAC | $143 | $35 | $178 | 0.81% |
| ZACHARY ALWEISS NIESEN3 | 35 UNDERHILL RD MILL VALLEY, CA 94941 | AFLAC | $52 | $73 | $125 | 0.57% |
| KRISTINA J KUNZ3 | 118 GRANVILLE WAY SAN FRANCISCO, CA 94127 | AFLAC | $102 | $21 | $123 | 0.56% |
| SCOTLAND O MILLER3 | 217 VILLA GARDEN DR APT C MILL VALLEY, CA 94941 | AFLAC | $47 | $52 | $99 | 0.45% |
| BYRON KINGSLEY JHA3 | 600 RAINBOW DR APT 229 MOUNTAIN VIEW, CA 94041 | AFLAC | $39 | $27 | $66 | 0.30% |
| DAVID B. KITCHEN3 Filed as: DAVID B KITCHEN | 1260 N DUTTON AVE STE 180 SANTA ROSA, CA 95401 | AFLAC | $22 | $6 | $28 | 0.13% |
| ACRISURE LLC3 | 2033 GATEWAY PL STE 150 SAN JOSE, CA 95110 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | — | $6K | 30.00% |
| ACRISURE LLC3 Filed as: PENTARISK INS DBA ACRISURE LLC | 2033 GATEWAY PLACE,STE 150 SAN JOSE, CA 95110 | CALIFORNIA DENTAL NETWORK, INC. | $216 | — | $216 | 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 | 119 | 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) | 119 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE SHIED OF CALIFORNIA | 126 | $942K |
| Dental(2 contracts, 2 carriers) | MONY LIFE INSURANCE COMPANY OF AMERICA | 82 | $82K |
| Vision | MONY LIFE INSURANCE COMPANY OF AMERICA | 82 | $80K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 40 | $19K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 115 | $14K |
| Prescription drug | BLUE SHIED OF CALIFORNIA | 126 | $714K |
| Other(2 contracts, 2 carriers) | AFLAC | 40 | $41K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 126 | — |
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.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.