| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9035 SOQUEL AVE STE 200 SANTA CRUZ, CA 95062 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $25K | $0 | $25K | 3.98% |
| PROGRESSIVE BENEFIT GROUP3 | 9035 SOQUEL AVENUE STREET 200 SANTA CRUZ, CA 95062 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $5K | $0 | $5K | 8.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9035 SOQUEL AVE #200 SANTA CRUZ, CA 95062 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $1K | $220 | $1K | 11.96% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9035 SOQUEL AVE STE 200 SANTA CRUZ, CA 95062 | VISION SERVICE PLAN | $765 | $0 | $765 | 7.34% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE EIN 59-1031071 N/A | Direct payment from the plan; Contract Administrator; Claims processing; Named fiduciary; Float revenue; Non-monetary compensation; Other services; Participant communication Service code 12 | — | $27K |
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 | 215 | 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) | 215 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 57 | $640K |
| Dental | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 150 | $62K |
| Vision | VISION SERVICE PLAN | 56 | $10K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 215 | $11K |
| Other | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 215 | $11K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 215 | — |
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.