| 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 | $16K | — | $16K | 3.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC DBA | VANTREO INSURANCE BROKERAGE 100 STONY POINT ROAD, STE 160 SANTA ROSA, CA 95401 | PREMIER ACCESS INSURANCE COMPANY | $7K | — | $7K | 6.58% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 STONY POINT RD STE 160 SANTA ROSA, CA 95401 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $409 | $2K | 12.13% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC DB | A VANTREO INSURANCE BROKERAGE 100 STONY POINT RD STE 160 SANTA ROSA, CA 95401 | VISION SERVICE PLAN | $901 | — | $901 | 6.35% |
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 | 186 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 187 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 96 | $538K |
| Dental | PREMIER ACCESS INSURANCE COMPANY | 201 | $105K |
| Vision | VISION SERVICE PLAN | 176 | $14K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 167 | $19K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 167 | $19K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 201 | — |
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."
No prospect flags tripped on this filing.