| 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 | 5.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 OTTAWA AVE GRAND RAPIDS, MI 49503 | ANTHEM BLUE CROSS | $7K | — | $7K | 4.05% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | DBA SUHR RISK SERVICES 5300 STEVENS CREEK BLVD FL 3 SAN JOSE, CA 95129 | PRINCIPAL LIFE INSURANCE COMPANY | $5K | — | $5K | 5.70% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 1414 SOQUEL AVE STE 105 SANTA CRUZ, CA 95062 | PRINCIPAL LIFE INSURANCE COMPANY | $4K | — | $4K | 4.30% |
| BENEFITS MATCHMAKING LLC3 Filed as: BENEFITS MATCHMAKING, LLC | DBA SUVAUN 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | PRINCIPAL LIFE INSURANCE COMPANY | $3K | — | $3K | 3.15% |
| GA SOLUTIONS LLC3 | 311 CLOCK TOWER CMNS BREWSTER, NY 10509 | PRINCIPAL LIFE INSURANCE COMPANY | $837 | — | $837 | 1.02% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | DBA BENEFITS DONE RIGHT 601 UNIVERSITY AVE STE 250 SACRAMENTO, CA 95825 | PRINCIPAL LIFE INSURANCE COMPANY | — | $778 | $778 | 0.95% |
| ACRISURE LLC3 | PO BOX 1788 GRAND RAPIDS, MI 49501 | PRINCIPAL LIFE INSURANCE COMPANY | — | $419 | $419 | 0.51% |
| ACRISURE LLC3 Filed as: ACRISURE OF CA LLC DBA PROCO | PO BOX 1788 GRAND RAPIDS, MI 49501 | CALIFORNIA DENTAL NETWORK, INC. | $278 | — | $278 | 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 | 122 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 122 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 50 | $523K |
| Dental(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 146 | $85K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 146 | $82K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 146 | $82K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 146 | — |
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.