| 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 | $113K | — | $113K | 5.86% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE, STE 410 CAMPBELL, CA 95008 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | — | $3K | 8.85% |
| PLANSOURCE BENEFITS ADMINISTRATION3 | 110 S GARLAND AVE, STE 203 ORLANDO, FL 32801 | METROPOLITAN LIFE INSURANCE COMPANY | — | $548 | $548 | 1.43% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 2055 WOODSIDE RD, STE 290 REDWOOD CITY, CA 94061 | METROPOLITAN LIFE INSURANCE COMPANY | $456 | — | $456 | 1.19% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 OTTAWA AVENUE SW GRAND RAPIDS, MI 49503 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 15.00% |
| BALTOR INSURANCE SERVICES3 | 11 AIRPORT BLVD SUITE 105 SOUTH SAN FRANCISCO, CA 94080 | CONTINENTAL AMERICAN INSURANCE COMPANY | $200 | — | $200 | 5.72% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | CONTINENTAL AMERICAN INSURANCE COMPANY | $199 | — | $199 | 5.69% |
| JOSHUA BALTOR3 Filed as: JOSHUA STEVEN BALTOR | 11 AIRPORT BLVD SUITE 105 SOUTH SAN FRANCISCO, CA 94080 | CONTINENTAL AMERICAN INSURANCE COMPANY | $87 | — | $87 | 2.49% |
| RUBEN ROSA3 | 933 LEE RD, 200 ORLANDO, FL 32810 | CONTINENTAL AMERICAN INSURANCE COMPANY | $28 | — | $28 | 0.80% |
| CHRIS KELLY3 | 1260 N DUTTON AVE STE 180 SANTA ROSA, CA 95401 | CONTINENTAL AMERICAN INSURANCE COMPANY | $23 | — | $23 | 0.66% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 16835 W BERNARDO, STE 212 SAN DIEGO, CA 92127 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON | $56 | — | $56 | 2.59% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 2055 WOODSIDE RD, STE 290 REDWOOD CITY, CA 94061 | SAFEGUARD HEALTH PLANS, INC A CALIFORNIA CORPORATION | $96 | — | $96 | 9.66% |
| PLANSOURCE BENEFITS ADMINISTRATION3 | 101 S GARLAND AVE, STE 203 ORLANDO, FL 32801 | SAFEGUARD HEALTH PLANS, INC A CALIFORNIA CORPORATION | — | $10 | $10 | 1.01% |
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 | 447 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 10 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 457 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 374 | $1.9M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 747 | $39K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 747 | $38K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 447 | $17K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 447 | $17K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 374 | $1.9M |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 447 | $20K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 747 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.