| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE STE 410 CAMPBELL, CA 95008 | KAISER FOUNDATION HEALTH PLAN INC | $73K | — | $73K | 5.35% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $10K | — | $10K | 6.23% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 28202 CABOT RD STE 600 LAGUNA NIGUEL, CA 92677 | SUN LIFE ASSURANCE COMPANY OF CANADA | $9K | — | $9K | 21.82% |
| ACRISURE LLC3 Filed as: ACRISURE OF CA, LLC DBA SUHR RISK S | 910 E. HAMILTON AVE., SUITE 410 CAMBELL, CA 95008 | EYEMED | $422 | — | $422 | 9.68% |
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 | 169 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 169 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 158 | $1.4M |
| Dental | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 169 | $154K |
| Vision | EYEMED | 65 | $4K |
| Life insurance(2 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 169 | $196K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 73 | $42K |
| Long-term disability | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 169 | $154K |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 73 | $42K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 169 | — |
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.