| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS | SERVICES 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | KAISER FOUNDATION HEALTH PLAN, INC, | $14K | $1 | $14K | 1.63% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 900 E HAMILTON AVE STE 500 CAMPBELL, CA 95008 | KAISER FOUNDATION HEALTH PLAN, INC, | $7K | — | $7K | 0.87% |
| ACRISURE LLC3 Filed as: ACRISURE WEST INS SRVCS | 900 E HAMILTON AVE STE 500 CAMPBELL, CA 95008 | AMERICAN FAMILY LIFE ASSURANCE COMPANY OF COLUMBUS | $8K | — | $8K | 15.00% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS | SERVICES LLC 3155 OLSEN DR SAN JOSE, CA 95117 | CALIFORNIACHOICE | $3K | — | $3K | 5.00% |
| BROWN & BROWN INSURANCE SERVICES3 Filed as: WORD & BROWN | — | CALIFORNIACHOICE | $2K | — | $2K | 4.36% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | $381 | $2K | 8.28% |
| ENROLLEASE3 Filed as: ENROLLEASE INC | 7979 OLD GEORGETOWN RD STE 300 BETHESDA, MD 20814 | METROPOLITAN LIFE INSURANCE COMPANY | — | $151 | $151 | 0.55% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 900 E HAMILTON AVE STE 500 CAMPBELL, CA 95008 | METROPOLITAN LIFE INSURANCE COMPANY | $716 | — | $716 | 10.91% |
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 | 132 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 132 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC, | 95 | $885K |
| Dental | AMERICAN FAMILY LIFE ASSURANCE COMPANY OF COLUMBUS | 86 | $56K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 79 | $7K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 132 | $27K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 132 | $27K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 132 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.