| 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 | $213K | — | $213K | 2.00% |
| PROCO INSURANCE SERVICES3 | 910 E HAMILTON AVE STE 410 CAMPBELL, CA 95008 | SUTTER HEALTH PLAN | $62K | — | $62K | 5.00% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $11K | $1K | $13K | 17.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3155 OLSEN DR STE 400 SAN JOSE, CA 95117 | VISION SERVICE PLAN | $7K | — | $7K | 10.00% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $1K | $7K | 12.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE CAMPBELL, CA 95008 | DELTA DENTAL OF CALIFORNIA | $3K | — | $3K | 10.00% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $371 | $1K | 8.00% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | UNUM INSURANCE COMPANY | $950 | $362 | $1K | 8.53% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | UNUM INSURANCE COMPANY | — | $338 | $338 | 2.87% |
| REMMEL SOLUTIONS4 | 1183 SWALLOWTAIL WAY NIPOMO, CA 93444 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $1K | — | $1K | 9.63% |
| ACRISURE LLC4 Filed as: ACRISURE OF CALIFORNIA LLC | 5300 STEVENS CREEK BLVD FL 3 SAN JOSE, CA 95159 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $976 | — | $976 | 8.41% |
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 | 1,034 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,038 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 1,319 | $11.9M |
| Dental | DELTA DENTAL OF CALIFORNIA | 211 | $28K |
| Vision | VISION SERVICE PLAN | 441 | $74K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,034 | $93K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 69 | $60K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 69 | $60K |
| Prescription drug | SUTTER HEALTH PLAN | 211 | $1.2M |
| Other(5 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,034 | $132K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,319 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.