| 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 | $38K | — | $38K | 4.06% |
| PROCO INSURANCE SERVICES3 | PO BOX 2540 MENLO PARK, CA 94026 | SUTTER HEALTH PLAN | $30K | — | $30K | 4.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DRIVE SE CALEDONIA, MI 49316 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $11K | $2K | $13K | 59.69% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3925 BOHANNON DR STE 100 MENLO PARK, CA 94025 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $279 | $2K | 11.31% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3925 BOHANNON DR STE 100 MENLO PARK, CA 94025 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $302 | $3K | 16.50% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC DBA PRO | 3925 BOHANNON DRIVE SUITE 100 MENLO PARK, CA 94025 | EYEMED | $2K | — | $2K | 8.23% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3925 BOHANNON DR STE 100 MENLO PARK, CA 94025 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $249 | $54 | $303 | 6.08% |
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 | 269 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 269 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 110 | $1.7M |
| Dental | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 165 | $22K |
| Vision | EYEMED | 213 | $19K |
| Life insurance(3 contracts, 2 carriers) | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 269 | $63K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 11 | $5K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 110 | $1.7M |
| Other(3 contracts, 2 carriers) | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 269 | $63K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 269 | — |
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."
No prospect flags tripped on this filing.