| 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. | $33K | — | $33K | 4.97% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3925 BOHANNON DR STE 100 MENLO PARK, CA 94025 | CALIFORNIA PHYSICIANS' SERVICE | $23K | — | $23K | 4.60% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 2055 WOODSIDE RD STE 290 REDWOOD CITY, CA 94061 | SUN LIFE ASSURANCE COMPANY OF CANADA | $3K | — | $3K | 25.17% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3 POLARIS WAY 4TH FLOOR ALISO VIEJO, CA 92656 | GUARDIAN | $943 | $212 | $1K | 12.25% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9140 E HAMILTON AVE #410 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $585 | $2K | 21.80% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9140 E HAMILTON AVE #410 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $611 | $2K | 22.97% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9140 E HAMILTON AVE #410 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $544 | $2K | 22.25% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9140 E HAMILTON AVE #410 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $799 | $355 | $1K | 21.66% |
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 | 108 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 109 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 88 | $1.2M |
| Vision | GUARDIAN | 101 | $9K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 102 | $13K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 40 | $7K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 48 | $9K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 59 | $509K |
| Other(3 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 102 | $27K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 102 | — |
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.