| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PATRIOT GROWTH INSURANCE SERVICES3 | 1465 N MCDOWELL BLVD SUITE 180 PETALUMA, CA 94954 | PRINCIPAL LIFE INSURANCE COMPANY | $21K | $6K | $27K | 11.70% |
| ALTERITY BROKER SOLUTIONS3 Filed as: ALTERITY BROKER SOLUTIONS INC. | 8777 NORTH GAINEY CENTER DRIVE SUITE 26 SCOTTSDALE, AZ 85258 | PRINCIPAL LIFE INSURANCE COMPANY | $9K | $0 | $9K | 3.95% |
| VOLUNTARY BENEFITS SPECIALISTS LLC3 | 289 FARRIS AVENUE LAS VEGAS, NV 89183 | TRANSAMERICA LIFE INSURANCE COMPANY | $19K | $0 | $19K | 100.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PATRIOT GROWTH INSURANCE SERVICES ADMINISTRATOR | Contract Administrator Service code 13 | 1465 N MCDOWELL BLVD SUITE 180 PETALUMA, CA 94954 | $21K |
| VOLUNTARY BENEFIT SPECIALIST ADMINISTRATOR | Contract Administrator Service code 13 | 289 FARRIS AVE LAS VEGAS, NV 89183 | $19K |
| ALTERITY BROKER SOLUTIONS INC ADMINISTRATOR | Contract Administrator Service code 13 | 8777 GAINEY CENTER DR SUITE 26 SCOTTSDALE, AZ 85258 | $9K |
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 | 174 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 175 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 227 | $1.3M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 186 | $229K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 186 | $229K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 186 | $229K |
| Short-term disability | TRANSAMERICA LIFE INSURANCE COMPANY | 214 | $19K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 186 | $229K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 227 | $1.3M |
| Other(4 contracts, 4 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 250 | $275K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 250 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.