| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 STONY POINT RD 160 SANTA ROSA, CA 95401 | CALIFORNIA PHYSICIANS' SERVICE | — | $73K | $73K | 5.19% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 10531 4S COMMONS DR STE 166 516 SAN DIEGO, CA 92127 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $7K | — | $7K | 4.98% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 1950 W CORPORATE WAY # 1 ANAHEIM, CA 92501 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 11.85% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 STONY POINT RD STE 160 SANTA ROSA, CA 95401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 4.37% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 1950 W CORPORATE WAY # 1 ANAHEIM, CA 92801 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 STONY POINT RD STE 160 SANTA ROSA, CA 95401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $676 | $676 | 4.42% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 1950 W CORPORATE WAY # 1 ANAHEIM, CA 92801 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 15.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 STONY POINT RD STE 160 SANTA ROSA, CA 95401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $649 | $649 | 4.58% |
| VANTREO INSURANCE BROKERAGE3 | 100 STONY POINT RD #160 SANTA ROSA, CA 95401 | MANAGED HEALTH NETWORK | $233 | — | $233 | 5.01% |
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 | 113 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 113 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA PHYSICIANS' SERVICE | 149 | $1.4M |
| Dental | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 172 | $144K |
| Vision | CALIFORNIA PHYSICIANS' SERVICE | 149 | $1.4M |
| Life insurance(2 contracts, 2 carriers) | BLUE SHIELD OF CALIFORNIA | 117 | $45K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 115 | $15K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 115 | $30K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 149 | $1.4M |
| Other(3 contracts, 3 carriers) | BLUE SHIELD OF CALIFORNIA | 117 | $50K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 172 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.