| 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 | $30K | — | $30K | 4.00% |
| VITA INSURANCE ASSOCIATES, INC.3 | 900 N. SHORELINE BLVD MOUNTAIN VIEW, CA 94043 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $4K | — | $4K | 3.12% |
| VITA INSURANCE ASSOCIATES, INC.3 | 900 N SHORELINE BLVD. MOUNTAIN VIEW, CA 94043 | KAISER FOUNDATION HEALTH PLAN OF COLORADO | $4K | — | $4K | 3.73% |
| VITA INSURANCE ASSOCIATES, INC.3 | 900 N. SHORELINE BLVD MOUNTAIN VIEW, CA 94043 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $3K | — | $3K | 4.46% |
| VITA INSURANCE ASSOCIATES, INC.3 | 900 N. SHORELINE BLVD MOUNTAIN VIEW, CA 94043 | VISION SERVICE PLAN | $2K | — | $2K | 3.36% |
| VITA INSURANCE ASSOCIATES, INC.3 | 900 N. SHORELINE BLVD MOUNTAIN VIEW, CA 94043 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $4K | — | $4K | 9.31% |
| VITA INSURANCE ASSOCIATES, INC.3 | 900 N. SHORELINE BOULEVARD MOUNTAIN VIEW, CA 94043 | DELTA DENTAL OF CALIFORNIA | $8K | — | $8K | 22.14% |
| VITA INSURANCE ASSOCIATES, INC.3 | 900 N. SHORELINE BLVD MOUNTAIN VIEW, CA 94043 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $3K | $3K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INS COMPANY EIN 59-1031071 TPA | Float revenue; Direct payment from the plan; Contract Administrator; Other services; Non-monetary compensation; Named fiduciary; Participant communication; Claims processing Service code 12 | — | $150K |
| VITA INSURANCE ASSOCIATES, INC. BROKER | Insurance agents and brokers Service code 22 | 900 NORTH SHORELINE BOULEVARD MOUNTAIN VIEW, CA 94043 | $83K |
| AMERICAN SPECIALTY HEALTH | Non-monetary compensation; Contract Administrator; Other services; Direct payment from the plan; Float revenue; Participant communication; Claims processing; Named fiduciary Service code 12 | — | $0 |
| CARECORE DBA EVICORE | Participant communication; Contract Administrator; Claims processing; Named fiduciary; Other services; Non-monetary compensation; Direct payment from the plan; Float revenue Service code 12 | — | $0 |
| CIGNA HEALTHY REWARDS VENDOR | Direct payment from the plan; Non-monetary compensation; Other services; Contract Administrator; Float revenue; Participant communication; Named fiduciary; Claims processing Service code 12 | — | $0 |
| MEDSOLUTIONS DBA EVICORE. INC. | Non-monetary compensation; Claims processing; Named fiduciary; Participant communication; Float revenue; Direct payment from the plan; Contract Administrator; Other services Service code 12 | — | $0 |
| U.S. BANK NATIONAL ASSOCIATION | Other services; Named fiduciary; Direct payment from the plan; Contract Administrator; Participant communication; Float revenue; Non-monetary compensation; Claims processing 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 | 347 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 32 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 4 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 383 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 344 | $865K |
| Dental | DELTA DENTAL OF CALIFORNIA | 325 | $38K |
| Vision | VISION SERVICE PLAN | 294 | $65K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 347 | $127K |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 347 | $74K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 347 | $46K |
| Prescription drug(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 344 | $865K |
| Other | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 347 | $127K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 347 | — |
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."
No prospect flags tripped on this filing.