| 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 | $157K | — | $157K | 4.81% |
| PROCO INSURANCE SERVICES3 | 910 E HAMILTON AVE, STE 410 CAMPBELL, CA 95008 | SUTTER HEALTH PLAN | $35K | — | $35K | 5.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE CAMPELL, CA 95008 | DELTA DENTAL OF CALIFORNIA | $27K | — | $27K | 10.00% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS OF WEST COAST | 3155 OLSEN DRIVE STE 400 SAN JOSE, CA 95117 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8K | $3K | $11K | 8.95% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE, STE 410 CAMPBELL, CA 95008 | VISION SERVICE PLAN | $1K | — | $1K | 4.41% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | 3155 OLSEN DRIVE SUITE 400 SAN JOSE, CA 95117 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $510 | $4K | 18.52% |
| SYNERGY ENROLLMENT AND BENEFITS LLC3 Filed as: SYNERGY ENROLLMENT AND BENEFITS | 3550 CAMINO DEL RIO N STE 207 SAN DIEGO, CA 92108 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $652 | — | $652 | 5.40% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC DBA | PROCO INSURANCE SERVICES 910 E HAMILTON AVE, STE 410 CAMPBELL, CA 95008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $280 | — | $280 | 2.32% |
| SYNERGY ENROLLMENT AND BENEFITS LLC3 | 3550 CAMINO DEL RIO N STE 207 SAN DIEGO, CA 92108 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $364 | — | $364 | 3.92% |
| 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 | $156 | — | $156 | 1.68% |
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 | 244 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 244 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 316 | $4.0M |
| Dental | DELTA DENTAL OF CALIFORNIA | 412 | $272K |
| Vision | VISION SERVICE PLAN | 195 | $33K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 246 | $144K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 32 | $9K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 246 | $120K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 316 | $4.0M |
| Other(5 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 246 | $168K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 412 | — |
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.