| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $153K | $0 | $153K | 16.56% |
| 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 | 2.35% |
| PROGRESSIVE BENEFIT GROUP3 | 9035 SOQUEL AVE STE 200 SANTA CRUZ, CA 950622033 | KAISER FOUNDATION HEALTH PLAN , INC. | $3K | $0 | $3K | 4.03% |
| PROGRESSIVE BENEFIT GROUP3 | 9035 SOQUEL AVE STE 2022 SANTA CRUZ, CA 950622033 | KAISER FOUNDATION HEALTH PLAN , INC. | $3K | $0 | $3K | 3.92% |
| 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 | $8K | $0 | $8K | 13.74% |
| 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 | $8K | $0 | $8K | 13.75% |
| 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 | 13.83% |
| 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 | $709 | $4K | 16.41% |
| PACIFIC ADVISORS LLC3 | — | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $58 | $0 | $58 | 0.26% |
| 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 | 13.85% |
| 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 | $1K | $0 | $1K | 13.93% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 ADMINISTRATOR | Contract Administrator; Direct payment from the plan; Claims processing; Other services; Participant communication; Named fiduciary; Non-monetary compensation; Float revenue Service code 12 | — | $161K |
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 ADMINISTRATOR | Contract Administrator; Direct payment from the plan; Claims processing; Other services; Participant communication; Named fiduciary; Non-monetary compensation; Float revenue Service code 12 | — | $38K |
| ACRISURE OF CALIFORNIA ADMINISTRATOR | Claims processing Service code 12 | 1414 SOQUEL AVE. SUITE 105 SANTA CRUZ, CA 95062 | $16K |
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 | 243 | 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) | 243 | 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 | 237 | $1.1M |
| Vision | VISION SERVICE PLAN | 243 | $127K |
| Short-term disability(3 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $55K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $60K |
| Other(4 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 63 | $106K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 243 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.