| 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 | ANTHEM BLUE CROSS LIFE AND INSURANCE COMPANY | $21K | — | $21K | 0.91% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 493168081 | KAISER FOUNDATION HEALTH PLAN | $8K | — | $8K | 1.21% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | DELTA DENTAL OF CALIFORNIA | $1K | — | $1K | 1.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC DBA PRO | 3925 BOHANNON DR STE 100 MENLO PARK, CA 94025 | RELIANCE STANDARD LIFE INSURANCE | $855 | — | $855 | 16.06% |
| NONE | — | DELTA DENTAL OF CALIFORNIA | — | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EIDE BAILLY LLP EIN 45-0250958 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $117K |
| PREFERRED BENEFIT INSURANCE ADMINIS EIN 94-3079635 NONE | Direct payment from the plan; Plan Administrator Service code 14 | — | $29K |
| KRAW LAW GROUP EIN 32-0465891 NONE | Legal; Direct payment from the plan Service code 29 | — | $11K |
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 | 0 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM BLUE CROSS LIFE AND INSURANCE COMPANY | 471 | $2.3M |
| Dental(2 contracts) | DELTA DENTAL OF CALIFORNIA | 277 | $122K |
| Vision | ANTHEM BLUE CROSS LIFE AND INSURANCE COMPANY | 471 | $2.3M |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE | 374 | $5K |
| Other | ANTHEM BLUE CROSS LIFE AND INSURANCE COMPANY | 471 | $2.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 471 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.