| 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 | $168K | $0 | $168K | 17.21% |
| GROUP BENEFITS LTD Filed as: GROUP BENEFITS, LTD. | 12006 RIDGEMONT DR URBANDALE, CA 950622033 | VISION SERVICE PLAN | $5K | $0 | $5K | 3.67% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA, LLC DBA PBG | 9035 SOQUEL AVE STE 200 SANTA CRUZ, CA 950622033 | VISION SERVICE PLAN | $3K | $0 | $3K | 2.30% |
| ACRISURE LLC Filed as: ACRISURE PARTNERS WEST COAST INSURA | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | VISION SERVICE PLAN | $16 | $0 | $16 | 0.01% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC, DBA PBG | 9035 SOQUEL AVE, STR 200 SANTA CRUZ, CA 95062 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $9K | $0 | $9K | 13.73% |
| PROGRESSIVE BENEFIT GROUP3 | 9035 SOQUEL AVE STE 2022 SANTA CRUZ, CA 950622033 | KAISER FOUNDATION HEALTH PLAN , INC. | $3K | $0 | $3K | 4.35% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC, DBA PBG | 9035 SOQUEL AVE STE 200 SANTA CRUZ, CA 95062 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $9K | $0 | $9K | 13.73% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC, DBA PBG | 9035 SOQUEL AVE STE 200 SANTA CRUZ, CA 95062 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $6K | $0 | $6K | 13.73% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9035 SOQUEL AVE STE 2022 SANTA CRUZ, CA 95062 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | $609 | $4K | 15.98% |
| PACIFIC ADVISORS LLC3 | — | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $58 | $0 | $58 | 0.26% |
| PROGRESSIVE BENEFIT GROUP3 | 9035 SOQUEL AVE STE 200 SANTA CRUZ, CA 950622033 | KAISER FOUNDATION HEALTH PLAN , INC. | $1K | $0 | $1K | 5.17% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC, DBA PBG | 9035 SOQUEL AVE STE 200 SANTA CRUZ, CA 95062 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $0 | $2K | 13.73% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC, DBA PBG | 9035 SOQUEL AVE STE 2022 SANTA CRUZ, CA 95062 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $875 | $0 | $875 | 13.79% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 ADMINISTRATOR | Non-monetary compensation; Claims processing; Contract Administrator; Named fiduciary; Float revenue; Participant communication; Other services; Direct payment from the plan Service code 12 | — | $224K |
| ACRISURE OF CALIFORNIA N/A | Insurance agents and brokers Service code 22 | 9035 SOQUEL AVE STE 200 SANTA CRUZ, CA 95062 | $17K |
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 | 263 | 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) | 263 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 265 | $1.1M |
| Vision | VISION SERVICE PLAN | 263 | $132K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $16K |
| Short-term disability(3 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $51K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $66K |
| Other(4 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 81 | $108K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 265 | — |
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.