| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PATRIOT GROWTH INSURANCE SERVICES3 | 95 S. MARKET STREET, SUITE 600 SAN JOSE, CA 95113 | CALIFORNIA PHYSICIANS' SERVICE | — | $132K | $132K | 3.62% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 501 OFFICE CENTER DRIVE, SUITE 215 FORT WASHINGTON, PA 19034 | CALIFORNIA PHYSICIANS' SERVICE | $54 | $123 | $177 | 0.00% |
| INNOVATIVE COST MANAGEMENT SERVICES3 | 95 S. MARKET STREET, SUITE 600 SAN JOSE, CA 95113 | KAISER FOUNDATION HEALTH PLAN INC. | $28K | — | $28K | 3.59% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 501 OFFICE CENTER DRIVE, SUITE 215 FORT WASHINGTON, PA 19034 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $20K | — | $20K | 4.00% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $54 | $54 | 0.01% |
| PATRIOT GROWTH INSURANCE SERVICES3 | PO BOX 107 SAN JOSE, CA 95103 | VISION SERVICE PLAN | $2K | — | $2K | 2.78% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 501 OFFICE CENTER DRIVE, SUITE 215 FORT WASHINGTON, PA 19034 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $1K | $100 | $1K | 3.50% |
| INNOVATIVE COST MANAGEMENT SERVICES3 | 95 MARKET ST, STE 600 SAN JOSE, CA 95113 | METROPOLITAN LIFE INSURANCE COMPANY | $690 | $302 | $992 | 5.77% |
| INNOVATIVE COST MANAGEMENT SERVICES3 | 95 MARKET ST, STE 600 SAN JOSE, CA 95113 | METROPOLITAN LIFE INSURANCE COMPANY | $730 | $373 | $1K | 7.43% |
| GIS BENEFITS INC3 Filed as: GIS NORTHERN CALIFORNIA | 315 MONTGOMERY ST, SUITE 900 SAN FRANCISCO, CA 94104 | METLIFE LEGAL PLANS | $2K | — | $2K | 14.93% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 2 NORTH MARKET STREET SUITE 600 SAN JOSE, CA 95113 | METLIFE LEGAL PLANS | $2K | — | $2K | 13.54% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN BENEFIT ADMINISTRATORS | PO BOX 9201, BLDG 1 SUITE 100 AUSTIN, TX 78766 | METLIFE LEGAL PLANS | — | $847 | $847 | 6.94% |
| INNOVATIVE COST MANAGEMENT SERVICES3 | 95 MARKET ST, STE 600 SAN JOSE, CA 95113 | METROPOLITAN LIFE INSURANCE COMPANY | $451 | $187 | $638 | 5.89% |
| INNOVATIVE COST MANAGEMENT SERVICES3 | 95 MARKET ST, STE 600 SAN JOSE, CA 95113 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | $863 | $3K | 23.21% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD 5TH FLOOR ROLLING MEADOWS, IL 60008 | FEDERAL INSURANCE COMPANY | $656 | $49 | $705 | 16.11% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD 5TH FLOOR ROLLING MEADOWS, IL 60008 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $410 | — | $410 | 10.01% |
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 | 277 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 285 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 591 | $4.5M |
| Vision | VISION SERVICE PLAN | 266 | $78K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 277 | $492K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 277 | $492K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 277 | $492K |
| Prescription drug(3 contracts, 3 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 591 | $4.5M |
| Other(9 contracts, 6 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 800 | $578K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 800 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.