| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| VITA INSURANCE ASSOCIATES, INC.3 | 900 N. SHORELINE BLVD MOUNTAIN VIEW, CA 94043 | KAISER FOUNDATION HEALTH PLAN INC | $23K | — | $23K | 4.41% |
| VITA INSURANCE ASSOCIATES, INC.3 | 900 N SHORELINE BLVD MOUNTAIN VIEW, CA 94043 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $4K | — | $4K | 4.23% |
| VITA INSURANCE ASSOCIATES, INC.3 | 900 N SHORELINE BLVD MOUNTAIN VIEW, CA 94043 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $3K | — | $3K | 6.37% |
| VITA INSURANCE ASSOCIATES, INC.3 | 900 N SHORELINE BLVD MOUNTAIN VIEW, CA 94043 | VISION SERVICE PLAN | $2K | — | $2K | 4.10% |
| VITA INSURANCE ASSOCIATES, INC.3 | 900 N SHORELINE BLVD MOUNTAIN VIEW, CA 94043 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $4K | — | $4K | 10.25% |
| VITA INSURANCE ASSOCIATES, INC.3 | 900 N SHORELINE BOULEVARD MOUNTAIN VIEW, CA 94043 | DELTA DENTAL OF CALIFORNIA | $7K | — | $7K | 22.50% |
| VITA INSURANCE ASSOCIATES, INC.3 | 900 NORTH SHORELINE BOULEVARD MOUNTAIN VIEW, CA 94043 | ACE AMERICAN INSURANCE COMPANY | $201 | — | $201 | 15.02% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| VITA INSURANCE ASSOCIATES, INC. BROKER | Insurance agents and brokers Service code 22 | 900 NORTH SHORELINE BOULEVARD MOUNTAIN VIEW, CA 94043 | $16K |
| AMERICAN SPECIALTY HEALTH | Participant communication; Named fiduciary; Float revenue; Claims processing; Contract Administrator; Direct payment from the plan; Other services; Non-monetary compensation Service code 12 | — | $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 | 288 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 293 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 117 | $572K |
| Dental | DELTA DENTAL OF CALIFORNIA | 532 | $30K |
| Vision | VISION SERVICE PLAN | 238 | $42K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 286 | $87K |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 286 | $45K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 286 | $38K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 117 | $572K |
| Other(2 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 347 | $88K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 532 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.