| 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 | $3K | $75K | $78K | 5.31% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE 410 CAMPBELL, CA 95008 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $7K | — | $7K | 5.04% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 STONY POINT RD 160 SANTA ROSA, CA 95401 | BLUE SHIELD OF CALIFORNIA | $6K | — | $6K | 10.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 1950 W CORPORATE WAY # 1 ANAHEIM, CA 92501 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $301 | $3K | 9.92% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 STONY POINT RD STE 160 SANTA ROSA, CA 95401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $802 | — | $802 | 2.54% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 1950 W CORPORATE WAY # 1 ANAHEIM, CA 92801 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $153 | $1K | 8.44% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 STONY POINT RD STE 160 SANTA ROSA, CA 95401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $403 | — | $403 | 2.53% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 1950 W CORPORATE WAY # 1 ANAHEIM, CA 92801 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $142 | $2K | 12.47% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 STONY POINT RD STE 160 SANTA ROSA, CA 95401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $500 | — | $500 | 3.54% |
| VANTREO INSURANCE BROKERAGE3 | 100 STONY POINT RD #160 SANTA ROSA, CA 95401 | MANAGED HEALTH NETWORK | $213 | — | $213 | 5.00% |
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 | 118 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 118 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA PHYSICIANS' SERVICE | 137 | $1.5M |
| Dental | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 161 | $145K |
| Vision | CALIFORNIA PHYSICIANS' SERVICE | 137 | $1.5M |
| Life insurance(2 contracts, 2 carriers) | BLUE SHIELD OF CALIFORNIA | 116 | $77K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 115 | $16K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 115 | $32K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 137 | $1.5M |
| Other(3 contracts, 3 carriers) | BLUE SHIELD OF CALIFORNIA | 116 | $82K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 161 | — |
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.