| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DRIVE SE CALEDONIA, MI 49316 | KAISER FOUNDATION HEALTH PLAN INC | $32K | $0 | $32K | 4.20% |
| ABD INS. AND FINANCIAL SVCS., INC.3 | 777 MARINERS ISLAND BOULEVARD SUITE 250 SAN MATEO, CA 94404 | KAISER FOUNDATION HEALTH PLAN INC | $6K | $0 | $6K | 0.78% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3925 BOHANNON DRIVE, SUITE 100 MENLO PARK, CA 94025 | WESTERN HEALTH ADVANTAGE | $15K | $0 | $15K | 5.89% |
| ABD INS. AND FINANCIAL SVCS., INC.3 | 3 WATERS PARK DRIVE, SUITE 100 SAN MATEO, CA 94403 | WESTERN HEALTH ADVANTAGE | $3K | $0 | $3K | 1.11% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | PO BOX 1788 GRAND RAPIDS, MI 49501 | UNITEDHEALTHCARE INSURANCE COMPANY | $5K | $0 | $5K | 6.18% |
| BEERE & PURVES INC3 | 1350 TREAT BOULEVARD, SUITE 470 WALNUT CREEK, CA 94597 | UNITEDHEALTHCARE INSURANCE COMPANY | $3K | $0 | $3K | 3.50% |
| ABD INS. AND FINANCIAL SVCS., INC.3 | 777 MARINERS ISLAND BOULEVARD SUITE 250 SAN MATEO, CA 94404 | UNITEDHEALTHCARE INSURANCE COMPANY | $621 | $0 | $621 | 0.82% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 2055 WOODSIDE ROAD, SUITE 290 REDWOOD CITY, CA 94061 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $6K | $0 | $6K | 8.28% |
| ABD INS. AND FINANCIAL SVCS., INC.3 | 777 MARINERS ISLAND BOULEVARD SUITE 250 SAN MATEO, CA 94404 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $1K | $0 | $1K | 1.63% |
| INTERNATIONAL PROINSURANCE SVCS LLC3 Filed as: INTERNATIONAL PROINSURANCE SVCS | 3925 BOHANNON DRIVE, SUITE 100 MENLO PARK, CA 94025 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $0 | $452 | $452 | 0.64% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 2055 WOODSIDE ROAD, SUITE 290 REDWOOD CITY, CA 94061 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | $333 | $7K | 11.45% |
| ABD INS. AND FINANCIAL SVCS., INC.3 | 3 WATERS PARK DRIVE, SUITE 100 SAN MATEO, CA 94403 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $941 | $55 | $996 | 1.64% |
| PLANSOURCE BENEFIT ADMINISTRATION3 | PO BOX 1313 ORLANDO, FL 32802 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $264 | $0 | $264 | 0.43% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3925 BOHANNON DRIVE, SUITE 100 MENLO PARK, CA 94025 | METROPOLITAN LIFE INSURANCE COMPANY | $1K | $0 | $1K | 9.40% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9655 GRANITE RIDGE DRIVE, SUITE 500 SAN DIEGO, CA 92123 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $266 | $266 | 2.02% |
| ABD INS. AND FINANCIAL SVCS., INC.3 | 777 MARINERS ISLAND BOULEVARD SUITE 250 SAN MATEO, CA 94404 | METROPOLITAN LIFE INSURANCE COMPANY | $191 | $0 | $191 | 1.45% |
| ABD INS. AND FINANCIAL SVCS., INC.3 | 3 WATERS PARK DRIVE, SUITE 100 SAN MATEO, CA 94403 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $10 | $10 | 0.08% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | PO BOX 1788 GRAND RAPIDS, MI 49501 | UNITEDHEALTHCARE OF CALIFORNIA | $614 | $0 | $614 | 6.31% |
| ABD INS. AND FINANCIAL SVCS., INC.3 | 777 MARINERS ISLAND BOULEVARD SUITE 250 SAN MATEO, CA 94404 | UNITEDHEALTHCARE OF CALIFORNIA | $67 | $0 | $67 | 0.69% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 2055 WOODSIDE ROAD, SUITE 290 REDWOOD CITY, CA 94061 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $379 | $14 | $393 | 4.61% |
| PLANSOURCE BENEFIT ADMINISTRATION3 | PO BOX 1313 ORLANDO, FL 32802 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $31 | $0 | $31 | 0.36% |
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 | 150 | 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) | 150 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 120 | $1.1M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 104 | $70K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 178 | $13K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 135 | $61K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 31 | $9K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 135 | $61K |
| Prescription drug(4 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 120 | $1.1M |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 135 | $61K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 178 | — |
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.