| 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 | $18K | — | $18K | 5.05% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE STE 410 CAMPBELL, CA 95008 | ANTHEM BLUE CROSS | $7K | — | $7K | 3.65% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | DBA PROCO INS SERVICES 910 E HAMILTON AVE, STE 410 CAMPBELL, CA 95008 | PRINCIPAL LIFE INSURANCE COMPANY | $8K | $2K | $10K | 13.12% |
| BENEFITS MATCHMAKING LLC3 Filed as: BENEFITS MATCHMAKING, LLC | DBA SUVAUN 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | PRINCIPAL LIFE INSURANCE COMPANY | $3K | — | $3K | 3.45% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INS SERVICES INC | ATTN ACCOUNTING DEPT. 32110 AGOURA RD WESTLAKE VLG, CA 91361 | PRINCIPAL LIFE INSURANCE COMPANY | $617 | $792 | $1K | 1.88% |
| ACRISURE LLC3 | PO BOX 1788 GRAND RAPIDS, MI 49501 | PRINCIPAL LIFE INSURANCE COMPANY | — | $792 | $792 | 1.06% |
| ACRISURE LLC3 Filed as: ACRISURE OF CA LLC DBA PROCO | 910 E. HAMILTON AVE. STE 410 CAMPBELL, CA 95008 | CALIFORNIA DENTAL NETWORK, INC. | $220 | — | $220 | 10.01% |
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 | 135 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 135 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 53 | $553K |
| Dental(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 157 | $77K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 157 | $75K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 157 | $75K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 157 | — |
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.