| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | BLUE SHIELD OF CALIFORNIA | — | $229K | $229K | 3.09% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | DELTA DENTAL OF CALIFORNIA | $24K | — | $24K | 5.42% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 OTTAWA AVENUE SW GRAND RAPIDS, MI 49503 | PRUDENTIAL | $13K | — | $13K | 5.00% |
| DISABILITY SPECIALISTS INC3 | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | PRUDENTIAL | $10K | — | $10K | 3.93% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL | — | $116 | $116 | 0.04% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | INSURANCE SERVICES, LLC 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | VISION SERVICE PLAN | $6K | — | $6K | 9.17% |
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 | 549 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 556 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE SHIELD OF CALIFORNIA | 712 | $7.4M |
| Dental | DELTA DENTAL OF CALIFORNIA | 780 | $445K |
| Vision | VISION SERVICE PLAN | 410 | $60K |
| Life insurance | PRUDENTIAL | 549 | $266K |
| Short-term disability | PRUDENTIAL | 549 | $266K |
| Long-term disability | PRUDENTIAL | 549 | $266K |
| Prescription drug | BLUE SHIELD OF CALIFORNIA | 712 | $7.4M |
| Other | PRUDENTIAL | 549 | $266K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 780 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.