| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PROGRESSIVE BENEFIT GROUP3 | 9035 SOQUEL AVE STE 200 SANTA CRUZ, CA 95062 | KAISER FOUNDATION HEALTH PLAN INC | $41K | $0 | $41K | 3.16% |
| PROGRESSIVE BENEFIT GROUP3 | 9035 SOQUEL AVE STE 200 SANTA CRUZ, CA 95062 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $297 | $4K | 10.82% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $2K | $2K | 5.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9035 SOQUEL AVE STE 200 SANTA CRUZ, CA 95062 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $894 | $623 | $2K | 4.49% |
| BRIAN W PATTEN3 Filed as: BRIAN PATTEN & ASSOCIATES | 120 MARGUERITE DR STE 101 CRANBERRY TOWNSHIP, PA 16066 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $894 | $0 | $894 | 2.65% |
| PROGRESSIVE BENEFIT GROUP3 | 9035 STE 225 SANTA CRUZ, CA 95062 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $225 | $4K | 15.85% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $1K | $1K | 5.00% |
| PROGRESSIVE BENEFIT GROUP3 | 9035 SOQUEL AVE STE 200 SANTA CRUZ, CA 95062 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $232 | $3K | 10.92% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $1K | $1K | 5.00% |
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 | 159 | 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) | 159 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 256 | $1.3M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 149 | $34K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 149 | $34K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 61 | $27K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 49 | $25K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 159 | $36K |
| Other(3 contracts, 3 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 378 | $65K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 378 | — |
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.