| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INNOVATIVE COST MANAGEMENT SERVICES4 | 95 S MARKET STREET, SUITE 600 SAN JOSE, CA 95113 | BLUE SHIELD OF CALIFORNIA | — | $66K | $66K | 2.56% |
| INNOVATIVE COST MANAGEMENT SERVICES4 | 95 S MARKET STREET, SUITE 600 SAN JOSE, CA 95113 | BLUE SHIELD OF CALIFORNIA | $49K | — | $49K | 1.89% |
| INNOVATIVE COST MANAGEMENT SERVICES4 Filed as: INNOVATIVE COST MANAGEMENT | 95 S MARKET STREET, SUITE 600 SAN JOSE, CA 95113 | VISION SERVICE PLAN | $701 | — | $701 | 2.98% |
| PATRIOT GROWTH INSURANCE SERVICES4 | 95 S MARKET STREET, SUITE 600 SAN JOSE, CA 95113 | VISION SERVICE PLAN | $513 | — | $513 | 2.18% |
| INNOVATIVE COST MANAGEMENT SERVICES4 | 95 S MARKET STREET, SUITE 600 SAN JOSE, CA 95113 | BLUE SHIELD OF CALIFORNIA | -$162 | — | -$162 | -0.92% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED ADMINISTRATIVE SERVICES EIN 94-1749354 NONE | Contract Administrator Service code 13 | 6800 SANTA TERESA BOULEVARD SUITE 100 SAN JOSE, CA 95119 | $48K |
| INEICH & COMPANY, LLP EIN 56-2552172 NONE | Accounting (including auditing) Service code 10 | 950 TOWER LANE SUITE 780 FOSTER CITY, CA 94404 | $10K |
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 | 295 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 20 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 315 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | BLUE SHIELD OF CALIFORNIA | 281 | $5.0M |
| Dental | DELTA DENTAL PLAN OF CALIFORNIA | 552 | $388K |
| Vision | VISION SERVICE PLAN | 143 | $24K |
| Life insurance | BLUE SHIELD OF CALIFORNIA | 301 | $18K |
| Prescription drug | BLUE SHIELD OF CALIFORNIA | 261 | $2.6M |
| Other | BLUE SHIELD OF CALIFORNIA | 301 | $18K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 552 | — |
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."
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.