| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PATRIOT GROWTH INSURANCE SERVICES3 | PO BOX 107 SAN JOSE, CA 951030107 | KAISER FOUNDATION HEALTH PLAN, INC. | $28K | — | $28K | 3.42% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 501 W OFFICE CENTER DR, SUITE 215 FORT WASHINGTON, PA 19034 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $19K | — | $19K | 4.00% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $56 | $56 | 0.01% |
| PATRIOT GROWTH INSURANCE SERVICES3 | PO BOX 107 SAN JOSE, CA 95103 | VISION SERVICE PLAN | $2K | — | $2K | 2.96% |
| PATRIOT GROWTH INSURANCE SERVICES3 | PO BOX 107 SAN JOSE, CA 95103 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $1K | — | $1K | 3.51% |
| INNOVATIVE COST MANAGEMENT SERVICES3 | 95 S MARKET ST, STE 600 SAN JOSE, CA 95113 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | — | $3K | 15.27% |
| GIS BENEFITS INC3 Filed as: GIS NORTHERN CALIFORNIA | 315 MONTGOMERY ST, SUITE 900 SAN FRANCISCO, CA 94104 | METLIFE LEGAL PLANS | $2K | — | $2K | 11.03% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 2 NORTH MARKET STREET SUITE 600 SAN JOSE, CA 95113 | METLIFE LEGAL PLANS | $2K | — | $2K | 10.00% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN BENEFIT ADMINISTRATORS | PO BOX 9201, BLDG 1 SUITE 100 AUSTIN, TX 78766 | METLIFE LEGAL PLANS | — | $940 | $940 | 5.13% |
| INNOVATIVE COST MANAGEMENT SERVICES3 | 95 S MARKET ST, STE 600 SAN JOSE, CA 95113 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | — | $2K | 14.98% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD 5TH FLOOR ROLLING MEADOWS, IL 60008 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $448 | — | $448 | 4.03% |
| INNOVATIVE COST MANAGEMENT SERVICES3 | 95 S MARKET ST, STE 600 SAN JOSE, CA 95113 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | — | $2K | 16.64% |
| INNOVATIVE COST MANAGEMENT SERVICES3 | 95 S MARKET ST, STE 600 SAN JOSE, CA 95113 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | — | $2K | 21.16% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD 5TH FLOOR ROLLING MEADOWS, IL 60008 | FEDERAL INSURANCE COMPANY | $656 | $59 | $715 | 16.34% |
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 | 261 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 39 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 300 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 104 | $853K |
| Vision | VISION SERVICE PLAN | 264 | $82K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 329 | $481K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 329 | $481K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 329 | $481K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 104 | $853K |
| Other(9 contracts, 6 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 752 | $575K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 752 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.