| 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 | $17K | — | $17K | 4.18% |
| LEAVITT GROUP3 Filed as: LEAVITT PACIFIC INS. BROKERS INC. | 1570 THE ALAMEDA SUITE 101 SAN JOSE, CA 951262335 | KAISER FOUNDATION HEALTH PLAN INC | $3K | — | $3K | 0.80% |
| 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 | $6K | $407 | $7K | 8.21% |
| GA SOLUTIONS LLC3 | 311 CLOCK TOWER CMNS BREWSTER, NY 10509 | PRINCIPAL LIFE INSURANCE COMPANY | — | $3K | $3K | 4.18% |
| LEAVITT GROUP3 Filed as: LEAVITT PACIFIC INSURANCE BROKERS | 1570 THE ALAMEDA SUITE 101 SAN JOSE, CA 95126 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | — | $2K | 2.29% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $6K | — | $6K | 33.34% |
| LEAVITT GROUP3 Filed as: LEAVITT PACIFIC INSURANCE BROKERS | 1570 THE ALAMEDA SAN JOSE, CA 951262335 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $1K | — | $1K | 6.50% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INS. SERVICES INC. | 32110 AGOURA RD. WOODLAND HILLS, CA 91361 | CALIFORNIA DENTAL NETWORK, INC. | $91 | — | $91 | 4.93% |
| LEAVITT GROUP3 Filed as: LEAVITT PACIFIC INS. BROKERS INC. | 1570 THE ALAMEDA GRAND RAPIDS, CA 49501 | CALIFORNIA DENTAL NETWORK, INC. | $33 | — | $33 | 1.79% |
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 | 134 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 134 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 51 | $427K |
| Dental(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 153 | $82K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 153 | $80K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 153 | $80K |
| Other | PRINCIPAL LIFE INSURANCE COMPANY | 153 | $80K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 153 | — |
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.