| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALFORNIA LLC | 3631 S HARBOR BLVD STE 200 SANTA ANA, CA 92704 | KAISER FOUNDATION HEALTH PLAN INC | $23K | — | $23K | 1.71% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $11K | $7K | $18K | 9.62% |
| TAGCO ASSOCIATES LP3 | 3350 PARK RIDGE BOERNE, TX 78006 | HARTFORD LIFE AND ACCIDENT | $3K | — | $3K | 10.00% |
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 | 173 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 173 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 279 | $1.4M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 182 | $188K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 182 | $188K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 182 | $188K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 182 | $188K |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 182 | $215K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 279 | — |
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.