| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH INSURANCE SVCS, LLC | 501 OFFICE CENTER DRIVE, SUITE 215 FT. WASHINGTON, PA 19034 | KAISER FOUNDATION HEALTH PLAN, INC. | $47K | $0 | $47K | 4.01% |
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH INSURANCE SVCS, LLC | 500 SILVER SPUR ROAD, SUITE 121 ROLLING HILLS ESTATES, CA 90275 | PRINCIPAL LIFE INSURANCE COMPANY | $7K | $4K | $11K | 11.07% |
| ROGERS BENEFIT GROUP INC4 Filed as: M ROGERS GROUP, LLC | PO BOX 853 GEORGETOWN, CO 80444 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $310 | $0 | $310 | 16.42% |
| PATRIOT GROWTH INSURANCE SERVICES4 Filed as: PATRIOT GROWTH INSURANCE SVCS, LLC | 501 OFFICE CENTER DRIVE, SUITE 215 FT. WASHINGTON, PA 19034 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $251 | $0 | $251 | 13.29% |
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 | 185 | 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) | 185 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN, INC. | 181 | $1.2M |
| Dental(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 256 | $96K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 256 | $96K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 256 | $96K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN, INC. | 181 | $1.2M |
| Other(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 256 | $98K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 256 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.