| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | PO BOX 1788 GRAND RAPIDS, MI 49501 | UNITEDHEALTHCARE INSURANCE COMPANY | $124K | — | $124K | 5.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | KAISER FOUNDATION HEALTH PLAN INC | $105K | — | $105K | 4.99% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 2055 WOODSIDE RD STE 290 REDWOOD CITY, CA 94061 | METROPOLITAN LIFE INSURANCE COMPANY | $40K | — | $40K | 9.51% |
| PLANSOURCE BENEFITS ADMINISTRATION3 | 101 S GARLAND STE 203 ORLANDO, FL 32801 | METROPOLITAN LIFE INSURANCE COMPANY | — | $4K | $4K | 0.86% |
| ACRISURE LLC3 Filed as: ACRISURE LLC OF CALIFORNIA LLC | 504 REDWOOD BLVD SUITE 240 NOVATO, CA 94947 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $9K | — | $9K | 5.62% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $75 | $75 | 0.05% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE SUITE 410 CAMPBELL, CA 95008 | CONTINENTAL AMERICAN INSURANCE COMPANY | $907 | — | $907 | 7.44% |
| BALTOR INSURANCE SERVICES3 | 11 AIRPORT BLVD SUITE 105 SAN FRANCISCO, CA 94080 | CONTINENTAL AMERICAN INSURANCE COMPANY | $733 | — | $733 | 6.01% |
| RUBEN ROSA3 | 5805 SEPULVEDA BLVD 700 SHERMAN OAKS, CA 91411 | CONTINENTAL AMERICAN INSURANCE COMPANY | $192 | — | $192 | 1.57% |
| JOSHUA BALTOR3 Filed as: JOSHUA STEVEN BALTOR | 11 AIRPORT BLVD SUITE 105 SAN FRANCISCO, CA 94080 | CONTINENTAL AMERICAN INSURANCE COMPANY | $18 | — | $18 | 0.15% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 2055 WOODSIDE RD STE 290 REDWOOD CITY, CA 94061 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $591 | — | $591 | 8.64% |
| PLANSOURCE BENEFITS ADMINISTRATION3 | 101 S GARLAND AVE STE 203 ORLANDO, FL 32801 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | — | $72 | $72 | 1.05% |
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 | 377 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 12 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 389 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 205 | $4.6M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 647 | $424K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 647 | $417K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 377 | $166K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 377 | $166K |
| Prescription drug(3 contracts, 3 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 205 | $4.6M |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 377 | $178K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 647 | — |
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.