| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | KAISER FOUNDATION HEALTH PLAN INC | $31K | — | $31K | 4.95% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE STE 410 CAMPBELL, CA 95008 | KAISER FOUNDATION HEALTH PLAN INC | $115 | — | $115 | 0.02% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | PO BOX 1788 GRAND RAPIDS, MI 49501 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $11K | — | $11K | 9.91% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC | 32110 AGOURA RD WESTLAKE VILLAGE, CA 91361 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | — | $4K | $4K | 3.54% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE STE 410 CAMPBELL, CA 95008 | SUN LIFE ASSURANCE COMPANY OF CANADA | $4K | — | $4K | 15.52% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | SUN LIFE ASSURANCE COMPANY OF CANADA | $954 | — | $954 | 4.15% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE SUITE 410 CAMPBELL, CA 95008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 15.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 HAMILTON AVE SUITE 410 CANPBELL, CA 95008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 15.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE SUITE 410 CAMPBELL, CA 95008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $854 | — | $854 | 15.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE SUITE 410 CAMPBELL, CA 95008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $223 | — | $223 | 15.03% |
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 | 127 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 127 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 74 | $618K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 127 | $114K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 127 | $114K |
| Life insurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 57 | $29K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2 | $9K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 3 | $20K |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 128 | $24K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 128 | — |
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.