| 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 | $53K | $3K | $55K | 5.27% |
| VANTREO INSURANCE BROKERAGE3 | 1950 W CORPORATE WAY #1 ANAHEIM, CA 92801 | SUTTER HEALTH PLAN | $29K | — | $29K | 5.00% |
| VANTREO INSURANCE BROKERAGE3 | 100 STONY POINT, STE 160 SANTA ROSA, CA 95401 | CYPRESS DENTAL ADMINISTRATORS | $6K | — | $6K | 5.48% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 1950 W CORPORATE WAY #1 ANAHEIM, CA 92801 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 STONY POINT RD STE 160 SANTA ROSA, CA 95401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $579 | $579 | 2.67% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 1950 W CORPORATE WAY #1 ANAHEIM, CA 92801 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 STONY POINT RD, STE 160 SANTA ROSA, CA 95401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $440 | $440 | 2.58% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 1950 W CORPORATE WAY #1 ANAHEIM, CA 92801 | AMERITAS LIFE INSURANCE CORP. | $1K | $262 | $2K | 11.96% |
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. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 139 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 93 | $1.6M |
| Dental | CYPRESS DENTAL ADMINISTRATORS | 107 | $112K |
| Vision | AMERITAS LIFE INSURANCE CORP. | 242 | $13K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 135 | $17K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 135 | $22K |
| Prescription drug | SUTTER HEALTH PLAN | 73 | $585K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 135 | $17K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 242 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.