| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FILICE INSURANCE AGENCY1 Filed as: FILICE INSURANCE SERVICES LLC | 900 E HAMILTON AVE STE 500 CAMPBELL, CA 95008 | KAISER FOUNDATION HEALTH PLAN, INC. | $23K | — | $23K | 1.97% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | KAISER FOUNDATION HEALTH PLAN, INC. | $12K | $1 | $12K | 1.04% |
| ACRISURE LLC3 Filed as: ACRISURE WEST INS SERVICES LLC | 900 EAST HAMILTON AVENUE SUITE 500 CAMPBELL, CA 95008 | BLUE CROSS OF CALIFORNIA | $30K | — | $30K | 4.54% |
| BEERE & PURVES INC3 | 500 YGNACIO VALLEY ROAD SUITE 450 WALNUT CREEK, CA 94586 | BLUE CROSS OF CALIFORNIA | — | $15K | $15K | 2.19% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 900 E HAMILTON AVE STE 500 CAMPBELL, CA 95008 | BLUE CROSS OF CALIFORNIA | $2K | — | $2K | 0.33% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS | 3155 OLSEN DR, STE 400 SAN JOSE, CA 95117 | PRINCIPAL LIFE INSURANCE COMPANY | $15K | $1K | $16K | 10.81% |
| GA SOLUTIONS LLC3 | 311 CLOCK TOWER CMNS BREWSTER, NY 10509 | PRINCIPAL LIFE INSURANCE COMPANY | — | $6K | $6K | 4.30% |
| ACRISURE LLC3 | PO BOX 1788 GRAND RAPIDS, MI 49501 | PRINCIPAL LIFE INSURANCE COMPANY | — | $3K | $3K | 1.83% |
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 | 128 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 128 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 151 | $1.8M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 239 | $145K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 239 | $145K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 239 | $145K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 239 | — |
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.