| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PAUL A MIFSUD3 | PO BOX 610520 SAN JOSE, CA 95161 | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | $18K | — | $18K | 2.35% |
| PAUL A MIFSUD3 | 2350 MISSION COLLEGE BOULEVARD SUITE 550 SANTA CLARA, CA 95054 | KAISER FOUNDATION HEALTH PLAN OF COLORADO | $12K | — | $12K | 5.31% |
| MELITA-MCDONALD INSURANCE SERVICES3 | PO BOX 610520 SAN JOSE, CA 95161 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | $1K | $5K | 4.60% |
| MELITA-MCDONALD INSURANCE SERVICES3 Filed as: MELITA-MCDONALD INSURANCE SVCS INC | PO BOX 610520 SAN JOSE, CA 95161 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $9K | — | $9K | 12.69% |
| MELITA-MCDONALD INSURANCE SERVICES3 | 50 WEST SAN FERNANDO STREET SUITE 1350 SAN JOSE, CA 95113 | KAISER FOUNDATION HEALTH PLAN INC | $2K | — | $2K | 5.07% |
| PAUL A MIFSUD3 | PO BOX 610520 SAN JOSE, CA 95161 | HMO COLORADO, INC. | $679 | — | $679 | 2.34% |
| MELITA-MCDONALD INSURANCE SERVICES3 | 50 WEST SAN FERNANDO STREET SUITE 1350 SAN JOSE, CA 95113 | VISION SERVICE PLAN | $904 | — | $904 | 6.31% |
| MELITA-MCDONALD INSURANCE SERVICES3 | PO BOX 610520 SAN JOSE, CA 95161 | BLUE CROSS OF CALIFORNIA | $3K | — | $3K | 67.13% |
| BEERE & PURVES INC3 | 1350 TREAT BOULEVARD, SUITE 470 WALNUT CREEK, CA 94597 | BLUE CROSS OF CALIFORNIA | — | $1K | $1K | 26.92% |
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 | 109 | 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) | 109 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 5 carriers) | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | 175 | $1.0M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 419 | $108K |
| Vision | VISION SERVICE PLAN | 91 | $14K |
| Life insurance(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 109 | $73K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 109 | $69K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 109 | $69K |
| Prescription drug(5 contracts, 5 carriers) | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | 175 | $1.0M |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 109 | $73K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 419 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.