| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| VITA INSURANCE ASSOCIATES, INC.3 | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $50K | — | $50K | 13.74% |
| VITA INSURANCE ASSOCIATES, INC.3 | — | KAISER FOUNDATION HEALTH PLAN INC. | $16K | $3 | $16K | 4.59% |
| VITA INSURANCE ASSOCIATES, INC.3 | — | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $23K | — | $23K | 7.76% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 TPA | Other services; Participant communication; Contract Administrator; Claims processing; Float revenue; Non-monetary compensation; Direct payment from the plan Service code 12 | — | $34K |
| CIGNA | Float revenue; Claims processing; Participant communication; Other services; Non-monetary compensation; Direct payment from the plan; Contract Administrator Service code 12 | — | $0 |
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 | 193 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 4 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 199 | 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 | 109 | $712K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 198 | $302K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 198 | $302K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 198 | $302K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 198 | $302K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 198 | $302K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 77 | $349K |
| Other(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 198 | $664K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 198 | — |
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.