| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 | 1950 WEST CORPORATE WAY SUITE 23968 ANAHEIM, CA 92801 | KAISER FOUNDATION HEALTH PLAN, INC. | $59K | — | $59K | 3.82% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INSURA | 100 OTTAWA AVENUE SW GRAND RAPIDS, MI 49503 | KAISER FOUNDATION HEALTH PLAN, INC. | $17K | — | $17K | 1.12% |
| GROUP BENEFITS LTD3 Filed as: GROUP BENEFITS, LTD | 12006 RIDGEMONT DRIVE URBANDALE, IA 50323 | VISION SERVICE PLAN | $2K | — | $2K | 6.01% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | 100 OTTAWA AVENUE SOUTHWEST GRAND RAPIDS, MI 49503 | VISION SERVICE PLAN | $948 | — | $948 | 3.50% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 3155 OLSEN DRIVE SUITE 400 SAN JOSE, CA 95117 | VISION SERVICE PLAN | $800 | — | $800 | 2.96% |
| PENTARISK3 | 2033 GATEWAY PLACE SAN JOSE, CA 95110 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 9.56% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $17K | — | $17K | 327.76% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $9K | $9K | 181.63% |
| PENTARISK3 | 2033 GATEWAY PLACE SAN JOSE, CA 95110 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $482 | — | $482 | 12.00% |
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 | 368 | 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) | 368 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN, INC. | 251 | $1.5M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 323 | $5K |
| Vision | VISION SERVICE PLAN | 218 | $27K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 368 | $20K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 368 | $4K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 368 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.