| 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 | $128K | — | $128K | 3.44% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INSURA | 100 OTTAWA AVE SW GRADN RAPIDS, MI 49503 | KAISER FOUNDATION HEALTH PLAN INC | $42K | $2 | $42K | 1.12% |
| PROCO INSURANCE SERVICES3 | 910 E HAMILTON AVE, STE 410 CAMPBELL, CA 95008 | SUTTER HEALTH PLAN | $51K | — | $51K | 5.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE CAMPELL, CA 95008 | DELTA DENTAL OF CALIFORNIA | $21K | — | $21K | 7.54% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INSURA | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | DELTA DENTAL OF CALIFORNIA | $7K | — | $7K | 2.45% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 18354 COLLINS ST UNIT A TARZANA, CA 91356 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | $1K | $9K | 11.45% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INSURA | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | VISION SERVICE PLAN | $1K | — | $1K | 4.52% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE, STE 410 CAMPBELL, CA 95008 | VISION SERVICE PLAN | $360 | — | $360 | 1.09% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 18354 COLLINS ST UNIT A TARZANA, CA 95117 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $464 | $3K | 9.45% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 18354 COLLINS ST UNIT A TARZANA, CA 91356 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $299 | $3K | 11.32% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | DBA PROCO INSURANCE SVCS 910 E HAMILTON AVE, STE 410 CAMPBELL, CA 95008 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | — | $0 | — |
| SYNERGY ENROLLMENT AND BENEFITS LLC3 | 3550 CAMINO DEL RIO N STE 207 SAN DIEGO, CA 92108 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | — | $0 | — |
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 | 261 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 262 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 290 | $4.7M |
| Dental | DELTA DENTAL OF CALIFORNIA | 406 | $273K |
| Vision | VISION SERVICE PLAN | 194 | $33K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 263 | $55K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 0 | $0 |
| Long-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 263 | $104K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 290 | $4.7M |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 263 | $55K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 406 | — |
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.