| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PROGRESSIVE BENEFIT GROUP3 | 9035 SOQUEL AVENUE STE 200 SANTA CRUZ, CA 950622033 | KAISER FOUNDATION HEALTH PLAN INC | $10K | $0 | $10K | 2.90% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | 12505 PARK POTOMAC AVE STE 300 POTOMAC, MD 208546805 | KAISER FOUNDATION HEALTH PLAN INC | $8K | $0 | $8K | 2.09% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA | 9035 SOQUEL AVE. STE 200 SANTA CRUZ, CA 950622033 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $15K | $0 | $15K | 8.21% |
| PROGRESSIVE BENEFIT GROUP3 | 9035 SOQUEL AVENUE STE 200 SANTA CRUZ, CA 950622033 | KAISER FOUNDATION HEALTH PLAN INC | $2K | $0 | $2K | 2.88% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | 12505 PARK POTOMAC AVE STE 300 POTOMAC, CA 950622033 | KAISER FOUNDATION HEALTH PLAN INC | $2K | $0 | $2K | 2.03% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON - HUNT VALLEY, | 12505 PARK POTOMAC AVE, BLDG E FLOOR 2 STE 225 POTOMAC, MD 20854 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $455 | $0 | $455 | 0.65% |
| PROGRESSIVE BENEFITS AGENCY INC3 Filed as: PROGRESSIVE BENEFITS GROUP | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $0 | $0 | $0 | 0.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC DBA PBG | 9035 SOQUEL AVE. SUITE 200 SANTA CRUZ, CA 95062 | IN SHAPE SOLUTIONS LLC | $1K | $0 | $1K | 5.95% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | 29727 NETWORK PLACE CHICAGO, IL 606731297 | IN SHAPE SOLUTIONS LLC | $718 | $0 | $718 | 4.09% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE EIN 59-1031071 N/A | Participant communication; Named fiduciary; Other services; Non-monetary compensation; Claims processing; Contract Administrator; Float revenue; Direct payment from the plan Service code 12 | — | $33K |
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 | 124 | 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) | 124 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 320 | $632K |
| Dental | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 124 | $70K |
| Vision | IN SHAPE SOLUTIONS LLC | 179 | $18K |
| Prescription drug | IN-SHAPE SOLUTIONS LLC | 320 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 320 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.