| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MELITA-MCDONALD INSURANCE SERVICES3 | P.O. BOX 610520 SAN JOSE, CA 95161 | UNITEDHEALTHCARE INSURANCE COMPANY | $51K | — | $51K | 5.00% |
| MELITA-MCDONALD INSURANCE SERVICES3 | P.O. BOX 610520 SAN JOSE, CA 95161 | KAISER FOUNDATION HEALTH PLAN INC. | $28K | — | $28K | 5.12% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE, INC. | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | KAISER FOUNDATION HEALTH PLAN INC. | $11K | — | $11K | 2.07% |
| MELITA-MCDONALD INSURANCE SERVICES3 | P.O. BOX 610520 SAN JOSE, CA 95161 | PRINCIPAL LIFE INSURANCE COMPANY | $14K | — | $14K | 9.32% |
| MELITA-MCDONALD INSURANCE SERVICES3 | P.O. BOX 610520 SAN JOSE, CA 95161 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | — | $3K | 20.00% |
| MELITA-MCDONALD INSURANCE SERVICES3 | P.O. BOX 610520 SAN JOSE, CA 95161 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | — | $1K | 10.00% |
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 | 226 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 226 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 180 | $1.6M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 226 | $151K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 226 | $151K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 91 | $15K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 73 | $15K |
| Prescription drug(2 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 180 | $1.6M |
| Other | RELIANCE STANDARD LIFE INSURANCE COMPANY | 91 | $15K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 226 | — |
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.