| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 175 S SAN ANTONIO RD #101 LOS ALTOS, CA 940223748 | KAISER FOUNDATION HEALTH PLAN INC | $6K | — | $6K | 1.05% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 200 GALLERIA PKWY SE STE 1950 ATLANTA, GA 30339 | HARTFORD LIFE & ACCIDENT | $29K | $19K | $48K | 8.35% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 200 GALLERIA PKWY SE STE 1950 ATLANTA, GA 30339 | SIMNSA | $1K | — | $1K | 1.00% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 200 GALLERIA PKWY SE STE 1950 ATLANTA, GA 30339 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $6K | — | $6K | 10.08% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 200 GALLERIA PKWY SE ATLANTA, GA 30339 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $6K | — | $6K | 10.11% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM HEALTH PLANS INC EIN 06-1475928 SERVICE PROVIDER - HLTH | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing; Insurance brokerage commissions and fees; Other fees; Other commissions; Float revenue; Other services; Insurance agents and brokers Service code 12 | — | $1.5M |
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 | 1,051 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 11 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,062 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 112 | $736K |
| Dental | SIMNSA | 83 | $132K |
| Vision(2 contracts) | FIDELITY SECURITY LIFE INSURANCE COMPANY | 1,346 | $123K |
| Life insurance | HARTFORD LIFE & ACCIDENT | 1,264 | $580K |
| Short-term disability | HARTFORD LIFE & ACCIDENT | 1,264 | $580K |
| Long-term disability | HARTFORD LIFE & ACCIDENT | 1,264 | $580K |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE & ACCIDENT | 1,264 | $711K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,346 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.