| 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 | $36K | — | $36K | 6.53% |
| INTERNATIONAL PROINSURANCE SERVICES3 | 3925 BOHANNON DR STE 100 MENLO PARK, CA 94025 | KAISER FOUNDATION HEALTH PLAN INC | $3K | — | $3K | 0.55% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3925 BOHANNON DR., STE 100 MENLO PARK, CA 94025 | CALIFORNIA PHYSICIANS' SERVICE | $21K | — | $21K | 5.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 2055 WOODSIDE RD STE 290 REDWOOD CITY, CA 94061 | SUN LIFE ASSURANCE COMPANY OF CANADA | $5K | — | $5K | 20.80% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3925 BOHANNON DR, STE 100 MENLO PARK, CA 94025 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $284 | $2K | 18.28% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3925 BOHANNON DR STE 100 MENLO PARK, CA 94025 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $260 | $2K | 18.01% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3925 BOHANNON DR STE 100 MENLO PARK, CA 94025 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $295 | $1K | 19.05% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3925 BOHANNON DR STE 100 MENLO PARK, CA 94025 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $779 | $203 | $982 | 18.92% |
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 | 91 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 91 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 82 | $971K |
| Vision | SUN LIFE ASSURANCE COMPANY OF CANADA | 98 | $22K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 91 | $12K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 44 | $9K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 49 | $9K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 50 | $417K |
| Other(3 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 98 | $35K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 98 | — |
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.