| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE STE 410 CAMPBELL, CA 95008 | KAISER FOUNDATION HEALTH PLAN INC | $29K | — | $29K | 4.28% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | KAISER FOUNDATION HEALTH PLAN INC | $5K | — | $5K | 0.79% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 423 MCGOARTY STREET SAN GABRIEL, CA 91776 | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | $3K | — | $3K | 3.92% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WORD & BROWN INSURANCE ADMINISTRATO | 721 S PARKER STREET ORANGE, CA 92868 | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | — | $1K | $1K | 1.94% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5300 STEVENS CREEK BLVD SAN JOSE, CA 95129 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $103 | $2K | 13.00% |
| DEBORAH LYNN WELLS3 | 5809 MARK TWAIN AVE SACRAMENTO, CA 95820 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $450 | $54 | $504 | 3.15% |
| DANIEL J BAZIS3 | 9218 SOUTH 168TH AVE CIRCLE OMAHA, NE 68136 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $181 | $61 | $242 | 1.51% |
| CASEY JAMES KUGLER3 | 906 HAWKS FEATHER LANE ROCKLIN, CA 95765 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $84 | $128 | $212 | 1.32% |
| STEPHANIE NOELLE KUGLER3 | 906 HAWKS FEATHER LANE ROCKLIN, CA 95765 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $149 | $41 | $190 | 1.19% |
| JENNA LEE DOSTAL3 | 9218 S 168TH AVE CIR OMAHA, NE 68136 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $129 | — | $129 | 0.81% |
| BRIAN ROBERT LLOYD3 | 3053 COPPERWOOD WAY EL DORADO HILLS, CA 95762 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $46 | $64 | $110 | 0.69% |
| ACRISURE LLC3 Filed as: ACRISURE | 3925 BOHANNON DR #100 MENLO PARK, CA 94025 | CALIFORNIA DENTAL NETWORK, INC. | $634 | — | $634 | 9.99% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 910 E HAMILTON AVE STE 410 CAMPBELL, CA 95008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $595 | $197 | $792 | 21.76% |
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 | 89 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 89 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 59 | $739K |
| Dental(2 contracts, 2 carriers) | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | 25 | $78K |
| Vision | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | 10 | $72K |
| Life insurance(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 91 | $20K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 91 | $4K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 91 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.