| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PATRIOT GROWTH INSURANCE SERVICES4 | 501 OFFICE CENTER DRIVE, SUITE 215 FORT WASHINGTON, PA 19034 | BLUE SHIELD OF CALIFORNIA | — | $70K | $70K | 2.50% |
| INNOVATIVE COST MANAGEMENT SERVICES4 | 95 S MARKET STREET, SUITE 600 SAN JOSE, CA 95113 | KAISER FOUNDATION HEALTH PLAN, INC. | $8K | — | $8K | 0.46% |
| INNOVATIVE COST MANAGEMENT SERVICES4 | 95 S MARKET STREET, SUITE 600 SAN JOSE, CA 95113 | KAISER FOUNDATION HEALTH PLAN, INC. | $3K | — | $3K | 0.35% |
| PATRIOT GROWTH INSURANCE SERVICES4 | P.O. BOX 107 SAN JOSE, CA 95103 | VISION SERVICE PLAN | $930 | — | $930 | 4.52% |
| PATRIOT GROWTH INSURANCE SERVICES4 | 501 OFFICE CENTER DRIVE, SUITE 215 FORT WASHINGTON, PA 19034 | BLUE SHIELD OF CALIFORNIA | $307 | — | $307 | 2.50% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 501 OFFICE CENTER DRIVE, SUITE 215 FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $299 | — | $299 | 10.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED ADMINISTRATIVE SERVICES EIN 94-1749354 NONE | Contract Administrator Service code 13 | 6800 SANTA TERESA BLVD, SUITE 100 SAN JOSE, CA 95119 | $43K |
| INEICH & COMPANY, LLP EIN 56-2552172 NONE | Accounting (including auditing) Service code 10 | 950 TOWER LANE, SUITE 780 FOSTER CITY, CA 94404 | $11K |
| NEYHART, ANDERSON, FLYNN & GROSBOLL EIN 94-2576729 NONE | Legal Service code 29 | 369 PINE STREET, SUITE 800 SAN FRANCISCO, CA 94104 | $6K |
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 | 253 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 17 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 270 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | BLUE SHIELD OF CALIFORNIA | 238 | $5.4M |
| Dental | DELTA DENTAL PLAN OF CALIFORNIA | 241 | $333K |
| Vision | VISION SERVICE PLAN | 114 | $21K |
| Life insurance(2 contracts, 2 carriers) | BLUE SHIELD OF CALIFORNIA | 259 | $15K |
| Prescription drug | BLUE SHIELD OF CALIFORNIA | 237 | $2.8M |
| Other(2 contracts, 2 carriers) | BLUE SHIELD OF CALIFORNIA | 259 | $15K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 259 | — |
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.