| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INSURA | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | KAISER FOUNDATION HEALTH PLAN, INC. | $27K | $1 | $27K | 3.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | KAISER FOUNDATION HEALTH PLAN, INC. | $9K | — | $9K | 1.01% |
| PROCO INSURANCE SERVICES3 | 910 E HAMILTON AVE STE 410 CAMPBELL, CA 95008 | SUTTER HEALTH PLAN | $22K | — | $22K | 4.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9140 E HAMILTON AVE #410 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $895 | $4K | 12.94% |
| EA LEGACY LLC5 | 1724 E 5TH AVE TAMPA, FL 33605 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $4K | $4K | 12.03% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3 POLARIS WAY TAMPA, FL 33605 | GUARDIAN | $10K | $923 | $11K | 43.30% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9140 E HAMILTON AVE #410 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $470 | $3K | 17.37% |
| EA LEGACY LLC5 | 1724 E 5TH AVE TAMPA, FL 33605 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $3K | $3K | 13.49% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9140 E HAMILTON AVE #410 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $518 | $241 | $759 | 7.33% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9140 E HAMILTON AVE #410 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $713 | $127 | $840 | 11.79% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9140 E HAMILTON AVE #410 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $676 | — | $676 | 9.99% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9140 E HAMILTON AVE #410 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $380 | $98 | $478 | 12.57% |
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 | 397 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 397 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 121 | $1.5M |
| Dental | GUARDIAN | 190 | $26K |
| Vision | EYEMED VISION CARE | 220 | $15K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 435 | $50K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 27 | $10K |
| Prescription drug | SUTTER HEALTH PLAN | 66 | $560K |
| Other(7 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 435 | $99K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 435 | — |
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.