| 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 | $128K | — | $128K | 4.99% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE STE 410 CAMPBELL, CA 95008 | METROPOLITAN LIFE INSURANCE COMPANY | $44K | — | $44K | 10.25% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | — | $5K | 1.23% |
| PLANSOURCE BENEFITS ADMINISTRATION3 | 101 S GARLAND AVE, STE 203 ORLANDO, FL 32801 | METROPOLITAN LIFE INSURANCE COMPANY | — | $5K | $5K | 1.17% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | DBA AHERN INS BROKERAGE 1615 MURRAY CANYON RD, STE 1050 SAN DIEGO, CA 92108 | METROPOLITAN LIFE INSURANCE COMPANY | — | $5K | $5K | 1.07% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 OTTAWA AVENUE SW GRAND RAPIDS, MI 49503 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $10K | — | $10K | 5.23% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 3.73% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $81 | $81 | 0.04% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 601 UNIVERSITY AVENUE SUITE 250 SACRAMENTO, CA 95825 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON | $1K | — | $1K | 2.60% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 100 OTTAWA AVENUE SW GRAND RAPIDS, MI 49503 | CONTINENTAL AMERICAN INSURANCE COMPANY | $2K | — | $2K | 6.70% |
| BALTOR INSURANCE SERVICES3 | 11 AIRPORT BLVD SUITE 105 SOUTH SAN FRANCISCO, CA 94080 | CONTINENTAL AMERICAN INSURANCE COMPANY | $2K | — | $2K | 6.58% |
| JOSHUA BALTOR3 Filed as: JOSHUA S BALTOR | 533 AIRPORT BLVD STE 400 SUITE 105 BURLINGAME, CA 94010 | CONTINENTAL AMERICAN INSURANCE COMPANY | $539 | — | $539 | 1.51% |
| CHRIS KELLY3 | 252 WIKIUP MEADOWS DR SANTA ROSA, CA 95403 | CONTINENTAL AMERICAN INSURANCE COMPANY | $307 | — | $307 | 0.86% |
| RUBEN ROSA3 | 933 LEE RD 200 ORLANDO, FL 32810 | CONTINENTAL AMERICAN INSURANCE COMPANY | $271 | — | $271 | 0.76% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: MATTHEW DOMINIC BROWN | 3093 RAE CREEK DRIVE CHICO, CA 95973 | CONTINENTAL AMERICAN INSURANCE COMPANY | $58 | — | $58 | 0.16% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC DBA | PROCO INSURANCE SE 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | KAISER FOUNDATION HEALTH PLAN, INC. | $311 | — | $311 | 3.50% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 OTTAWA AVENUE SW GRAND RAPIDS, MI 49503 | SAFEGUARD HEALTH PLANS, INC, A CALIFORNIA CORPORATION | $950 | — | $950 | 11.48% |
| PLANSOURCE BENEFITS ADMINISTRATION3 | 101 S GARLAND AVE STE 203 ORLANDO, FL 32801 | SAFEGUARD HEALTH PLANS, INC, A CALIFORNIA CORPORATION | — | $95 | $95 | 1.15% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | DBA AHERN INSURANCE BROKERAGE 1615 MURRAY CANYON RD, STE 1050 SAN DIEGO, CA 92108 | SAFEGUARD HEALTH PLANS, INC, A CALIFORNIA CORPORATION | — | $90 | $90 | 1.09% |
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 | 378 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 14 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 392 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC | 326 | $2.6M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 673 | $441K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 673 | $433K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 379 | $188K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 379 | $188K |
| Prescription drug(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC | 326 | $2.6M |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 379 | $224K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 673 | — |
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.