| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE STE 410 CAMPBELL, CA 95008 | KAISER FOUNDATION HEALTH PLAN INC | $88K | $2 | $88K | 4.99% |
| SUHR RISK SERVICES3 | 910 E HAMILTON AVE, SUITE 410 CAMPBELL, CA 95008 | DELTA DENTAL | $14K | — | $14K | 10.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 910 E HAMILTON AVE STE 410 CAMPBELL, CA 95008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $834 | $6K | 13.28% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | DBA SUHR RISK SVCS OF 910 E HAMILTON AVE, STE 410 CAMPBELL, CA 95008 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $163 | $3K | 10.98% |
| HAYS COMPANIES, INC.3 | 80 SOUTH 8TH STREET SUITE 700 MINNEAPOLIS, MN 55402 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 3.63% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 HAMILTON AVE STE 410 CAMPBELL, CA 95008 | VISION SERVICE PLAN | $1K | — | $1K | 4.11% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 910 E HAMILTON AVE STE 410 CAMPBELL, CA 95008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $431 | $4K | 17.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | DBA SUHR RISK SVCS OF 910 E HAMILTON AVE, STE 410 CAMPBELL, CA 95008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $44 | $2K | 10.89% |
| HAYS COMPANIES, INC.3 | 80 SOUTH 8TH STREET SUITE 700 MINNEAPOLIS, MN 55402 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $657 | — | $657 | 3.42% |
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 | 201 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 201 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 252 | $1.8M |
| Dental | DELTA DENTAL | 297 | $139K |
| Vision | VISION SERVICE PLAN | 158 | $26K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 201 | $63K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 18 | $29K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 201 | $42K |
| Other(3 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 201 | $82K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 297 | — |
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.