| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NORTHGATE BENEFITS3 Filed as: NORTHGATE BENEFITS AND INS SVS | 384 BEL MARIN KEYS BLVD STE 100 NOVATO, CA 94949 | PRINCIPAL LIFE INSURANCE COMPANY | $23K | — | $23K | 9.19% |
| AMWINS3 Filed as: AMWINS CONNECT INS SERVICES | 2677 N MAIN ST STE 800 SANTA ANA, CA 92705 | PRINCIPAL LIFE INSURANCE COMPANY | — | $11K | $11K | 4.42% |
| NORTHGATE BENEFITS3 Filed as: NORTHGATE BENEFITS AND INS SVS | 384 BEL MARIN KEYS BLVD STE 100 NOVATO, CA 94949 | KAISER FOUNDATION HEALTH PLAN INC | $12K | — | $12K | 4.94% |
| JOHN G JAKIEMIEC3 Filed as: JOHN JAKIEMIEC | 384 BEL MARIN KEYS BLVD STE 100 NOVATO, CA 94949 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $269 | — | $269 | 3.00% |
No Schedule C service providers reported on this filing.
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 | 121 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1 | 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)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 30 | $308K |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 232 | $255K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 232 | $255K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 232 | $255K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 232 | $255K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 232 | $255K |
| Prescription drug(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 30 | $308K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 232 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.