| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LUMITY, INC.3 Filed as: LUMITY INSURANCE SERVICES | 71 E. 3RD AVENUE SAN MATEO, CA 94401 | UNITED HEALTHCARE INSURANCE COMPANY | $22K | — | $22K | 4.61% |
| LUMITY, INC.3 Filed as: LUMITY INSURANCE SERVICES | 71 E. 3RD AVENUE SAN MATEO, CA 94401 | KAISER FOUNDATION HEALTH PLAN INC. | $18K | — | $18K | 4.96% |
| LUMITY, INC.3 Filed as: LUMITY INSURANCE SERVICES | 71 E. 3RD AVENUE SAN MATEO, CA 94401 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 10.00% |
| BENEFITMALL3 | 12404 PARK CENTRAL DRIVE DALLAS, TX 75251 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $955 | $955 | 5.00% |
| LUMITY, INC.3 Filed as: LUMITY INSURANCE SERVICES | 71 E. 3RD AVENUE SAN MATEO, CA 94401 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 10.00% |
| BENEFITMALL3 | 12404 PARK CENTRAL DRIVE DALLAS, TX 75251 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $526 | $526 | 5.00% |
| LUMITY, INC.3 Filed as: LUMITY INSURANCE SERVICES | 71 E. 3RD AVENUE SAN MATEO, CA 94401 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $973 | — | $973 | 10.00% |
| BENEFITMALL3 | 12404 PARK CENTRAL DRIVE DALLAS, TX 75251 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $486 | $486 | 5.00% |
| LUMITY, INC.3 Filed as: LUMITY INSURANCE SERVICES | 71 E. 3RD AVENUE SAN MATEO, CA 94401 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $468 | — | $468 | 10.00% |
| BENEFITMALL3 | 12404 PARK CENTRAL DRIVE DALLAS, TX 75251 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $234 | $234 | 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 | 150 | 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) | 151 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNITED HEALTHCARE INSURANCE COMPANY | 120 | $830K |
| Dental | UNITED HEALTHCARE INSURANCE COMPANY | 120 | $470K |
| Vision | UNITED HEALTHCARE INSURANCE COMPANY | 120 | $470K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 150 | $10K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 150 | $11K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 150 | $19K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 77 | $361K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 150 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 150 | — |
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.