| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| VITA INSURANCE ASSOCIATES, INC.3 | 900 NORTH SHORELINE BOULEVARD MOUNTAIN VIEW, CA 94043 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $28K | $3K | $32K | 9.64% |
| VITA INSURANCE ASSOCIATES, INC.3 | 1451 GRANT ROAD, SUITE 200 MOUNTAIN VIEW, CA 94040 | KAISER FOUNDATION HEALTH PLAN, INC. | $13K | $0 | $13K | 4.57% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 2677 NORTH MAIN STREET, SUITE 800 SANTA ANA, CA 92705 | KAISER FOUNDATION HEALTH PLAN, INC. | $2K | $0 | $2K | 0.75% |
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 | 105 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 20 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 131 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN, INC. | 26 | $294K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 115 | $327K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 115 | $327K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 115 | $327K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 115 | $327K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 115 | $327K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN, INC. | 26 | $294K |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 115 | $327K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 115 | — |
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.