| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA | 910 E HAMILTON AVE 410 CAMPBELL, CA 95008 | BLUE CROSS OF CALIFORNIA | $95K | $0 | $95K | 3.20% |
| PROGRESSIVE BENEFIT GROUP3 | 9035 SOQUEL AVE SUITE 200 SANTA CRUZ, CA 95062 | BLUE CROSS OF CALIFORNIA | $31K | $0 | $31K | 1.06% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 1600 WEST HILLSDALE BLVD SAN MATEO, CA 94402 | BLUE CROSS OF CALIFORNIA | $0 | -$12K | -$12K | -0.42% |
| PROGRESSIVE BENEFIT GROUP3 | 9035 SOQUEL AVE STE 200 SANTA CRUZ, CA 95062 | KAISER FOUNDATION HEALTH PLAN REGION | $20K | $0 | $20K | 3.62% |
| PROGRESSIVE BENEFIT GROUP3 | 9035 SOQUEL AVE SUITE 200 SANTA CRUZ, CA 95062 | KAISER FOUNDATION HEALTH PLAN | $16K | $0 | $16K | 3.67% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9035 SOQUEL AVE STE 200 SANTA CRUZ, CA 95062 | METROPOLITAN LIFE INSURANCE COMPANY | $20K | $0 | $20K | 5.70% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9655 GRANITE RIDGE DR STE 5000 SAN DIEGO, CA 92123 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $3K | $3K | 0.93% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 9035 SOQUEL AVE STE 200 SANTA CRUZ, CA 950622033 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8K | $349 | $8K | 10.46% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC | 9035 SOQUEL AVE SUITE 200 SANTA CRUZ, CA 95062 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $9K | $662 | $10K | 17.31% |
| PACIFIC ADVISORS LLC3 | 333 INDIAN HILL BLVD CLAREMONT, CA 91711 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $175 | $0 | $175 | 0.32% |
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 | 372 | 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) | 372 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 228 | $4.0M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 804 | $349K |
| Vision(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 804 | $3.3M |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 372 | $77K |
| Short-term disability | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 89 | $55K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 372 | $132K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 804 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.