| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PBG PROFESSIONAL INSURANCE SERVICES3 | 9035 SOQUEL AVE SUITE 200 SANTA CRUZ, CA 950622033 | SUTTER HEALTH PLUS | $70K | $0 | $70K | 4.00% |
| PROGRESSIVE BENEFIT GROUP3 | 9035 SOQUEL AVE SUITE 200 SANTA CRUZ, CA 95062 | KAISER PERMANENTE | $26K | $0 | $26K | 4.01% |
| PROGRESSIVE BENEFIT GROUP3 | 9035 SOQUEL AVENUE STE 200 SANTA CRUZ, CA 950622033 | DELTA DENTAL | $12K | $0 | $12K | 4.85% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9035 SOQUEL AVENUE STE 200 SANTA CRUZ, CA 950622033 | DELTA DENTAL | $8K | $0 | $8K | 3.49% |
| PROGRESSIVE BENEFIT GROUP3 | 9035 SOQUEL AVE SUITE 200 SANTA CRUZ, CA 95062 | CIGNA HEALTH AND LIFE INSURANC COMPANY | $3K | $0 | $3K | 6.35% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA | 9035 SOQUEL AVE STE 200 SANTA CRUZ, CA 95062 | CIGNA HEALTH AND LIFE INSURANC COMPANY | $2K | $0 | $2K | 3.91% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC DB | 9035 SOQUEL AVE SANTA CRUZ, CA 950622033 | VISION SERVICE PLAN | $941 | $0 | $941 | 2.34% |
| PROGRESSIVE BENEFIT GROUP3 | 9035 SOQUEL AVE STE 200 SANTA CRUZ, CA 950622033 | VISION SERVICE PLAN | $788 | $0 | $788 | 1.96% |
| PROGRESSIVE BENEFIT GROUP3 | 9035 SOQUEL AVE SUITE 200 SANTA CRUZ, CA 95062 | MUTUAL OF OMAHA | $6K | $0 | $6K | 15.00% |
| PROGRESSIVE BENEFIT GROUP3 | 9035 SOQUEL AVE SUITE 200 SANTA CRUZ, CA 950622033 | MUTUAL OF OMAHA | $0 | $2K | $2K | 6.08% |
| PROGRESSIVE BENEFIT GROUP3 | 9035 SOQUEL AVE SUITE 200 SANTA CRUZ, CA 950622033 | MUTUAL OF OMAHA | $0 | — | $0 | 0.00% |
| JAMES W. MOORADIAN3 Filed as: JAMES W MOORADIAN | 277 DARTMOUTH ST 4H FLOOR BOSTON, MA 02116 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $1K | $4K | 15.20% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9035 SOQUEL AVENUE STREET 200 SANTA CRUZ, CA 95062 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $0 | $1K | 3.86% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9035 SOQUEL AVENUE STREET 200 SANTA CRUZ, CA 950622033 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $45 | $0 | $45 | 0.15% |
| PROGRESSIVE BENEFITS AGENCY INC3 Filed as: PROGRESSIVE BENEFITS GROUP | 9035 SOQUEL AVENUE STE 200 SANTA CRUZ, CA 950622033 | EMPATHIA PACIFIC, INC | $0 | $0 | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH & LIFE INURANCE CO. EIN 59-1031071 N/A | Named fiduciary; Direct payment from the plan; Contract Administrator; Non-monetary compensation; Claims processing; Float revenue; Other services; Participant communication Service code 12 | — | $4K |
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 | 227 | 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) | 227 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(6 contracts, 5 carriers) | SUTTER HEALTH PLUS | 309 | $2.5M |
| Dental | DELTA DENTAL | 209 | $243K |
| Vision | VISION SERVICE PLAN | 206 | $40K |
| Life insurance(2 contracts, 2 carriers) | MUTUAL OF OMAHA | 227 | $69K |
| Short-term disability | MUTUAL OF OMAHA | 227 | $39K |
| Long-term disability | MUTUAL OF OMAHA | 227 | $39K |
| Prescription drug(2 contracts, 2 carriers) | SUTTER HEALTH PLUS | 309 | $2.4M |
| Other(2 contracts, 2 carriers) | MUTUAL OF OMAHA | 227 | $50K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 309 | — |
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."
No prospect flags tripped on this filing.