| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PATRIOT GROWTH INSURANCE SERVICES3 | PO BOX 750004 PETALUMA, CA 94975 | KAISER FOUNDATION HEALTH PLAN, INC. | $60K | $0 | $60K | 2.55% |
| ARROW BENEFITS GROUP3 Filed as: ARROW BENEFITS | PO BOX 750004 PETALUMA, CA 94975 | SUTTER HEALTH PLAN | $8K | $0 | $8K | 5.00% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 1465 N MCDOWELL BLVD PETALUMA, CA 94954 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $8K | $0 | $8K | 8.75% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ARROW BENEFITS ADMINISTRATORS | Contract Administrator Service code 13 | PO BOX 750004 PETALUMA, CA 94975 | $0 |
| PATRIOT GROWTH INSURANCE SERVICES ADMINISTRAORS | Contract Administrator Service code 13 | 1465 N MCDOWELL BLVD PETALUMA, CA 94954 | $0 |
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 | 244 | 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) | 245 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 273 | $2.5M |
| Dental | DIRECT DENTAL ADMINISTRATORS, LLC | 223 | $16K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 206 | $86K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 206 | $86K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 206 | $86K |
| Prescription drug | SUTTER HEALTH PLAN | 21 | $160K |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 206 | $86K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 273 | — |
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.