| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MELITA-MCDONALD INSURANCE SERVICES3 Filed as: MELITA-MCDONALD INS. SERVICES, INC. | PO BOX 610520 SAN JOSE, CA 95161 | BLUE CROSS OF CALIFORNIA | $258K | — | $258K | 2.97% |
| BEERE & PURVES INC3 Filed as: BEERE AND PURVES, INC. | 1350 TREAT BOULEVARD, SUITE 470 WALNUT CREEK, CA 94597 | BLUE CROSS OF CALIFORNIA | — | $172K | $172K | 1.98% |
| MELITA-MCDONALD INSURANCE SERVICES3 Filed as: MELITA-MCDONALD INS. SERVICES, INC. | PO BOX 610520 SAN JOSE, CA 95161 | METROPOLITAN LIFE INSURANCE COMPANY | $29K | $4K | $32K | 4.32% |
| MELITA-MCDONALD INSURANCE SERVICES3 Filed as: MELITA-MCDONALD INS.SERVICES, INC. | 50 WEST SAN FERNANDO STREET SUITE 1350 SAN JOSE, CA 95113 | KAISER FOUNDATION HEALTH PLAN INC | $20K | — | $20K | 2.93% |
| MELITA-MCDONALD INSURANCE SERVICES3 Filed as: MELITA-MCDONALD INS. SERVICES, INC. | PO BOX 610520 SAN JOSE, CA 95161 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $36K | $1K | $37K | 10.31% |
| MELITA-MCDONALD INSURANCE SERVICES3 Filed as: MELITA-MCDONALD INS. SERVICES, INC. | 50 WEST SAN FERNANDO STREET SUITE 1350 SAN JOSE, CA 95113 | VISION SERVICE PLAN | $3K | — | $3K | 2.39% |
| MERCER HEALTH AND BENEFITS, LLC3 | 1166 AVENUE OF THE AMERICAS NEW YORK, NY 10036 | ACE AMERICAN INSURANCE COMPANY | $7K | — | $7K | 20.00% |
| MELITA-MCDONALD INSURANCE SERVICES3 Filed as: MELITA-MCDONALD INS. SERVICES, INC. | PO BOX 610520 SAN JOSE, CA 95151 | CONCERN EAP | $664 | — | $664 | 5.00% |
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 | 630 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 9 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 639 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 1,256 | $9.4M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 1,792 | $750K |
| Vision | VISION SERVICE PLAN | 569 | $121K |
| Life insurance(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 1,256 | $9.1M |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 560 | $359K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 560 | $359K |
| Prescription drug(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 1,256 | $9.4M |
| Other(4 contracts, 4 carriers) | BLUE CROSS OF CALIFORNIA | 1,256 | $9.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,792 | — |
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.