| 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 | $31K | — | $31K | 4.17% |
| NAC INSURANCE ADMINISTRATION CORPOR3 | P O BOX 640 CAPITOLA, CA 95010 | KAISER FOUNDATION HEALTH PLAN | $6K | — | $6K | 0.80% |
| VANTREO INSURANCE BROKERAGE3 | 100 STONY POINT, STE 160 SANTA ROSA, CA 95401 | CYPRESS DENTAL ADMINISTRATORS | $617 | — | $617 | 1.66% |
| NAC INSURANCE ADMINISTRATION CORPOR3 | P O BOX 640 CAPITOLA, CA 95010 | CYPRESS DENTAL ADMINISTRATORS | $240 | — | $240 | 0.65% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 STONY POINT RD STE 160 SANTA ROSA, CA 95401 | VISION SERVICE PLAN | $139 | — | $139 | 2.55% |
| NAC INSURANCE ADMINISTRATION CORPOR3 | P O BOX 640 CAPITOLA, CA 95010 | VISION SERVICE PLAN | $77 | — | $77 | 1.41% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3 POLARIS WAY 4TH FLOOR ALISO VIEJO, CA 92656 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $357 | — | $357 | 8.04% |
| NAC INSURANCE ADMINISTRATION CORPOR3 | P O BOX 640 CAPITOLA, CA 95010 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $259 | — | $259 | 5.83% |
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 | 142 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 142 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN | 91 | $753K |
| Dental | CYPRESS DENTAL ADMINISTRATORS | 102 | $37K |
| Vision | VISION SERVICE PLAN | 91 | $5K |
| Life insurance | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 142 | $4K |
| Long-term disability | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 142 | $4K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN | 91 | $753K |
| Other | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 142 | $4K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 142 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.