| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INSURA | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | KAISER FOUNDATION HEALTH PLAN, INC. | $38K | — | $38K | 3.71% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | KAISER FOUNDATION HEALTH PLAN, INC. | $12K | — | $12K | 1.19% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | PO BOX 1788 GRAND RAPIDS, MI 49501 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $13K | — | $13K | 9.90% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | 32110 AGOURA RD WESTLAKE VILLAGE, CA 91361 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | — | $5K | $5K | 3.96% |
| ACRISURE LLC3 Filed as: ACRISURE WEST INSURANCE SERVICES | 3155 OLSEN DRIVE, SUITE 400 SAN JOSE, CA 95117 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | — | $612 | $612 | 0.46% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INSURA | 3155 OLSEN DR SUITE 400 SAN JOSE, CA 95117 | SUN LIFE ASSURANCE COMPANY OF CANADA | $5K | — | $5K | 14.96% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | SUN LIFE ASSURANCE COMPANY OF CANADA | $2K | — | $2K | 4.87% |
| ACRISURE LLC3 | 1460 US HIGHWAY 9 N SUITE 307 WOODBRIDGE, NJ 07095 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $232 | $232 | 0.73% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3155 OLSEN DR STE 400 SAN JOSE, CA 95117 | SUN LIFE ASSURANCE COMPANY OF CANADA | $113 | — | $113 | 0.35% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC DBA | PROCO INS 910 E HAMILTON AVENUE, SUITE 410 CAMPBELL, CA 95008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 15.00% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | INSURANCE SERVICES, LLC 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | VISION SERVICE PLAN | $1K | — | $1K | 10.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC DBA | PROCO INS 910 E HAMILTON AVENUE, SUITE 410 CAMPBELL, CA 95008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 15.59% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC DBA | PROCO INS 910 E HAMILTON AVENUE, SUITE 410 CAMPBELL, CA 95008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 15.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC DBA | PROCO INS 910 E HAMILTON AVENUE, SUITE 410 CAMPBELL, CA 95008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $331 | — | $331 | 15.02% |
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 | 163 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 163 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN, INC. | 93 | $1.0M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 160 | $132K |
| Vision | VISION SERVICE PLAN | 155 | $14K |
| Life insurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 165 | $40K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 165 | $7K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 165 | $26K |
| Other(3 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 165 | $60K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 165 | — |
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.