| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| VITA INSURANCE ASSOCIATES, INC.3 Filed as: VITA INSURANCE ASSOCIATES INC. | 900 N. SHORELINE BLVD MOUNTAIN VIEW, CA 94043 | CALIFORNIA PHYSICIANS' SERVICE | $114K | $65 | $114K | 5.00% |
| ROGERS BENEFIT GROUP INC3 Filed as: ROGERS BENEFIT GROUP INC. | 6155 ALMADEN EXPWY #210 SAN JOSE, CA 95120 | CALIFORNIA PHYSICIANS' SERVICE | $0 | $46K | $46K | 2.00% |
| VITA INSURANCE ASSOCIATES, INC.3 Filed as: VITA INSURANCE ASSOCIATES INC. | 900 N SHORELINE BLVD MOUNTAIN VIEW, CA 94043 | KAISER FOUNDATION HEALTH PLAN INC | $37K | — | $37K | 4.58% |
| VITA INSURANCE ASSOCIATES, INC.3 Filed as: VITA INSURANCE ASSOCIATES INC. | 900 N SHORELINE BLVD MOUNTAIN VIEW, CA 94043 | PRINCIPAL LIFE INSURANCE COMPANY | $39K | — | $39K | 10.00% |
| VITA INSURANCE ASSOCIATES, INC.3 Filed as: VITA INSURANCE ASSOCIATES INC. | 900 N SHORELINE BLVD MOUNTAIN VIEW, CA 94043 | VISION SERVICE PLAN | $2K | — | $2K | 2.96% |
| VITA INSURANCE ASSOCIATES, INC.3 Filed as: VITA INSURANCE ASSOCIATES INC. | 900 N SHORELINE BLVD MOUNTAIN VIEW, CA 94043 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8K | $216 | $8K | 10.16% |
| VITA INSURANCE ASSOCIATES, INC.3 Filed as: VITA INSURANCE ASSOCIATES | 900 N SHORELINE BOULEVARD MOUNTAIN VIEW, CA 94043 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $1K | — | $1K | 20.00% |
| VITA INSURANCE ASSOCIATES, INC.3 | 900 NORTH SHORELINE BLVD MOUNTAIN VIEW, CA 94043 | FIRST UNUM LIFE INSURANCE COMPANY | $128 | $1 | $129 | 26.76% |
| BENEPLUS INSURANCE PRODUCERS3 Filed as: BENEPLUS INSURANCE PRODUCERS A | 900 N SHORELINE BLVD MOUNTAIN VIEW, CA 94043 | FIRST UNUM LIFE INSURANCE COMPANY | — | $7 | $7 | 1.45% |
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 | 433 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 23 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 458 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 561 | $3.1M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 777 | $391K |
| Vision | VISION SERVICE PLAN | 471 | $83K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 455 | $79K |
| Short-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 455 | $79K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 455 | $79K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 561 | $3.1M |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 455 | $86K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 777 | — |
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.