Form 5500 · Employee benefit plan · SAN FRANCISCO, CA
EVERGREEN SERVICES GROUP, LLC
The filing calls this plan EVERGREEN SERVICES GROUP, LLC HEALTH AND WELFARE BENEFIT PLAN.
EVERGREEN SERVICES GROUP, LLC of SAN FRANCISCO, CA insures health, dental, vision, life and disability coverage for its employees, per Schedule A of its Form 5500. Its broker of record is ALLIANT INSURANCE SERVICES, INC.. Coverage is written through CIGNA HEALTH AND LIFE INSURANCE COMPANY and 5 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 36-4877994 · plan 501 · plan year 2024, filed Sep 16, 2025
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5,257 other employer plans in California have policy years ending in December. See the full list on the renewal calendar, or ask for it in Claude or ChatGPT.
How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
Benefits declared on this filing
Also declared: prepaid legal, death benefits.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 6 insured contracts covering health, dental, vision, life and disability; the largest, with CIGNA HEALTH AND LIFE INSURANCE COMPANY, covers 1,019 people.
Reported premium across the insured contracts is $6,037,492, with $293,242 in disclosed broker commissions — about 4.9% of premium.
The health contract's policy period ended in December, while at least one ancillary line's policy period ended in August. The plan is on a split renewal cycle.
ALLIANT INSURANCE SERVICES, INC. is the broker of record on 3 of the 6 contracts; the rest name a different broker or none.
6 carriers appear on the filing, including CIGNA HEALTH AND LIFE INSURANCE COMPANY, KAISER FOUNDATION HEALTH PLAN, INC., UNUM LIFE INSURANCE COMPANY OF AMERICA and METROPOLITAN LIFE INSURANCE COMPANY. CIGNA HEALTH AND LIFE INSURANCE COMPANY writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY | Health, Dental, Vision | 1,019 | Jan 1, 2025 | $5,406,133 | $221,099 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA | Life, Disability | 726 | Jan 1, 2025 | $237,150 | $32,369 |
| METROPOLITAN LIFE INSURANCE COMPANY | — | 460 | Jan 1, 2025 | $133,885 | $26,977 |
| KAISER FOUNDATION HEALTH PLAN, INC. | Health | 41 | Jan 1, 2025 | $237,896 | $12,797 |
| METLIFE LEGAL PLANS | — | 96 | Sep 1, 2024 | $16,506 | $0 |
| METLIFE GENERAL INSURANCE COMPANY | — | 94 | Jan 1, 2025 | $5,922 | $0 |
Premium and claims on this contract
CIGNA HEALTH AND LIFE INSURANCE COMPANY, contract 3345931. For the contract year on this filing, the carrier reported $5,406,133 in premium earned and $7,531,009 in claims incurred. Dividing one by the other gives 139%.
- CIGNA HEALTH AND LIFE INSURANCE COMPANY, contract 3345931 reported $453,564 in retention.
Retention is what the carrier kept of the premium after claims, as reported: administration, commissions and other charges.
Only experience-rated contracts report these figures, so most filings leave them blank.
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
How this plan compares
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Renewal calendar
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