| 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 | SUN LIFE ASSURANCE COMPANY OF CANADA | $120K | — | $120K | 3.32% |
| UNITED BENEFIT ADVISORS LLC3 Filed as: UNITED BENEFIT ADVISORS INC | 10 WYNSHIRE LANE RED LION, PA 17356 | SUN LIFE ASSURANCE COMPANY OF CANADA | $6K | — | $6K | 0.18% |
| ACE BENEFIT PARTNERS, INC.3 | 1990 N CALIFORNIA BLVD STE 900 WALNUT CREEK, CA 94596 | RELIASTAR LIFE INSURANCE COMPANY | $30K | $52K | $82K | 7.86% |
| UMR, INC.3 Filed as: UMR INC | MARY GOSZ MAIL STOP 7320 11 SCOTT ST STE 100 WAUSAU, WI 544034888 | RELIASTAR LIFE INSURANCE COMPANY | — | $31K | $31K | 3.00% |
| VITA INSURANCE ASSOCIATES, INC.3 Filed as: VITA INSURANCE ASSOCIATES INC | 900 N SHORELINE BLVD MOUNTAIN VIEW, CA 94043 | SUN LIFE ASSURANCE COMPANY OF CANADA | $33K | — | $33K | 3.43% |
| UNITED BENEFIT ADVISORS LLC3 Filed as: UNITED BENEFIT ADVISORS INC | 10 WYNSHIRE LANE RED LION, PA 17356 | SUN LIFE ASSURANCE COMPANY OF CANADA | $2K | — | $2K | 0.22% |
| VITA INSURANCE ASSOCIATES, INC.3 Filed as: VITA INSURANCE ASSOCIATES INC | 900 N SHORELINE BLVD. MOUNTAIN VIEW, CA 94043 | SUN LIFE ASSURANCE COMPANY OF CANADA | $26K | — | $26K | 3.19% |
| UNITED BENEFIT ADVISORS LLC3 Filed as: UNITED BENEFIT ADVISORS INC | 10 WYNSHIRE LANE RED LION, PA 17356 | SUN LIFE ASSURANCE COMPANY OF CANADA | $1K | — | $1K | 0.18% |
| AGIS NETWORK INC3 | 2122 KRATKY RD ST LOUIS, MO 63114 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $68K | $12K | $79K | 11.74% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX, INC EIN 33-0441200 PHARMACY BENEFIT MANAGMNT | Other fees; Direct payment from the plan; Claims processing; Float revenue Service code 12 | — | $3.3M |
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $530K |
| METROPOLITAN LIFE INSURANCE COMPANY EIN 13-5581829 CLAIMS PROCESSOR | Contract Administrator; Claims processing Service code 12 | — | $81K |
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 | 1,169 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 36 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 1 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 1,207 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNITEDHEALTHCARE OF CALIFORNIA | 40 | $214K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,169 | $806K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,170 | $949K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,171 | $3.6M |
| Prescription drug(2 contracts, 2 carriers) | UNITEDHEALTHCARE OF CALIFORNIA | 40 | $206K |
| Stop-loss / reinsurancereinsurance | RELIASTAR LIFE INSURANCE COMPANY | 1,127 | $1.0M |
| Other(3 contracts, 3 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,172 | $1.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,172 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.