| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | SERVICES, INC. 160 W SANTA CLARA ST STE 450 SAN JOSE, CA 951131762 | KAISER FOUNDATION HEALTH PLAN INC | $30K | — | $30K | 2.72% |
| ACRISURE LLC3 | 2033 GATEWAY PL STE 150 SAN JOSE, CA 951103710 | KAISER FOUNDATION HEALTH PLAN INC | $19K | — | $19K | 1.76% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SRVC(OH) | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $19K | — | $19K | 3.97% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $16K | — | $16K | 3.30% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SRVC (OH) | P.O. BOX 632886 CINCINNATI, OH 452632886 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | $9K | — | $9K | 5.12% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 2033 GATEWAY PLACE SUITE 150 SAN JOSE, CA 95110 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | $8K | — | $8K | 4.82% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | PO BOX 632886 ATTN COMMISSIONS CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 9.81% |
| ACRISURE LLC3 | 2033 GATEWAY SAN JOSE, CA 95110 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 5.11% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | PO BOX 632886 ATTN COMMISSIONS CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 9.80% |
| ACRISURE LLC3 | 2033 GATEWAY PLACE SUITE 150 SAN JOSE, CA 95110 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 5.12% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | SERVICE INC PO BOX 632886 CINCINNATI, OH 452632886 | VISION SERVICE PLAN | $570 | — | $570 | 2.91% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 2033 GATEWAY PL STE 150 SAN JOSE, CA 951103710 | VISION SERVICE PLAN | $527 | — | $527 | 2.69% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | PO BOX 632886 ATTN COMMISSIONS CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 9.81% |
| ACRISURE LLC3 | 2033 GATEWAY SAN JOSE, CA 95110 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $671 | — | $671 | 5.11% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | PO BOX 632886 ATTN COMMISSIONS CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $384 | — | $384 | 9.80% |
| ACRISURE LLC3 | 2033 GATEWAY SAN JOSE, CA 95110 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $201 | — | $201 | 5.13% |
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 | 200 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 3 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 206 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 126 | $1.6M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 123 | $174K |
| Vision | VISION SERVICE PLAN | 121 | $20K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 208 | $20K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 208 | $13K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 208 | $29K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 208 | $4K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 208 | — |
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.