| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 SOUTH 8TH STREET SUITE 700 MINNEAPOLIS, MN 55402 | KAISER FOUNDATION HEALTH PLAN INC. | $9K | — | $9K | 1.61% |
| VITA INSURANCE ASSOCIATES, INC.3 Filed as: VITA INSURANCE ASSOCIATES INC. | 1451 GRANT ROAD SUITE 200 MOUNTAIN VIEW, CA 94040 | KAISER FOUNDATION HEALTH PLAN INC. | $6K | — | $6K | 1.12% |
| VITA INSURANCE ASSOCIATES, INC.3 Filed as: VITA INSURANCE ASSOC INC. | 900 N. SHORELINE BLVD. MOUNTAIN VIEW, CA 94043 | BLUE OF CALIFORNIA (CALIFORNIA PHYSICIANS' SERVICE) | $18K | — | $18K | 7.00% |
| VITA INSURANCE ASSOCIATES, INC.3 Filed as: VITA INSURANCE ASSOCIATES INC. | 1451 GRANT ROAD SUITE 200 MOUNTAIN VIEW, CA 94040 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $4K | — | $4K | 7.94% |
| VITA INSURANCE ASSOCIATES, INC.3 Filed as: VITA INSURANCE ASSOCIATES INC. | 1451 GRANT ROAD SUITE 200 MOUNTAIN VIEW, CA 94040 | SUN LIFE ASSURANCE COMPANY OF CANADA | $1K | — | $1K | 12.24% |
| VITA INSURANCE ASSOCIATES, INC.3 Filed as: VITA INSURANCE ASSOCIATES INC. | 1451 GRANT ROAD SUITE 200 MOUNTAIN VIEW, CA 94040 | SUNLIFE AND HEALTH INSURANCE COMPANY (US) | $5 | — | $5 | 15.15% |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 145 | $835K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 104 | $49K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 104 | $49K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 145 | $9K |
| Short-term disability | SUNLIFE AND HEALTH INSURANCE COMPANY (US) | 1 | $33 |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 75 | $825K |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 145 | $9K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 145 | — |
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.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.