| 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 | $94K | — | $94K | 4.48% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALFORNIA LLC | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | ANTHEM BLUE CROSS | $14K | — | $14K | 5.03% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 HAMILTON AVE SUITE 410 CAMPBELL, CA 95008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 15.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE STE 410 CAMPBELL, CA 95008 | VISION SERVICE PLAN | $2K | — | $2K | 5.25% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE SUITE 410 CAMPBELL, CA 95008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 10.00% |
| ACRISURE LLC3 Filed as: ACRISURE WEST REGION | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $631 | — | $631 | 10.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE SUITE 410 CAMPBELL, CA 95008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $403 | — | $403 | 10.00% |
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 | 209 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 210 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 336 | $2.4M |
| Vision | VISION SERVICE PLAN | 200 | $29K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 209 | $20K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 209 | $29K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 209 | $4K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 336 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.