| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 5664 PRAIRIE CREEK DRIVE SE CALEDONIA, MI 49316 | KAISER FOUNDATION HEALTH PLAN INC | $19K | — | $19K | 2.47% |
| ACRISURE LLC3 Filed as: ACRISURE OF CA DBA BENEFITS DONE RI | 601 UNIVERSITY AVE STE 250 SACRAMENTO, CA 95825 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $39K | — | $39K | 16.18% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS | 3155 OLSEN DR STE 400 SAN JOSE, CA 95117 | PRINCIPAL LIFE INSURANCE COMPANY | $14K | — | $14K | 5.95% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC DBA | BENEFITS DONE RIGHT INS AGENCY 601 UNIVERSITY AVE STE 250 SACRAMENTO, CA 95825 | PRINCIPAL LIFE INSURANCE COMPANY | $10K | $514 | $10K | 4.27% |
| ACRISURE LLC3 | PO BOX 1788 GRAND RAPIDS, MI 49501 | PRINCIPAL LIFE INSURANCE COMPANY | — | $1K | $1K | 0.51% |
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 | 267 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 267 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 150 | $1.0M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 323 | $236K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 323 | $236K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 323 | $236K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 323 | $236K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 323 | $236K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 323 | — |
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.