| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LEAVITT GROUP3 Filed as: LEAVITT PACIFIC INSURANCE BROKERS | 695 CAMPBELL TECHNOLOGY CAMPBELL, CA 95008 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $60K | — | $60K | 5.24% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC | 32110 AGOURA RD. WESTLAKE, CA 91361 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $27K | — | $27K | 2.36% |
| LEAVITT GROUP3 Filed as: LEAVITT PACIFIC INSURANCE BROKERS | 1570 THE ALAMEDA SUITE 101 SAN JOSE, CA 95126 | PRINCIPAL LIFE INSURANCE COMPANY | $8K | — | $8K | 6.88% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SVCS. INC. | 32110 AGOURA RD. WESTLAKE, CA 91361 | PRINCIPAL LIFE INSURANCE COMPANY | $4K | $979 | $5K | 4.13% |
| LEAVITT GROUP3 Filed as: LEAVITT GROUP AGENCY ASSOC LLC | PO BOX 130 CEDAR CITY, UT 847210135 | PRINCIPAL LIFE INSURANCE COMPANY | — | $489 | $489 | 0.40% |
| LEAVITT GROUP3 Filed as: LEAVITT PACIFIC INSURANCE BROKERS | 1750 THE ALAMEDA STE 101 SAN JOSE, CA 951262335 | KAISER FOUNDATION HEALTH PLAN INC. | $3K | — | $3K | 3.68% |
| LEAVITT GROUP3 Filed as: LEAVITT PACIFIC INSURANCE BROKERS | 1570 THE ALAMEDA SUITE 101 SAN JOSE, CA 951262335 | VISION SERVICE PLAN | $1K | — | $1K | 6.36% |
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 | 115 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 116 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 136 | $1.2M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 174 | $123K |
| Vision | VISION SERVICE PLAN | 90 | $16K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 174 | $123K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 174 | $123K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 174 | $123K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 136 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 174 | — |
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.