| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| VITA INSURANCE ASSOCIATES, INC.3 | 900 N. SHORELINE BLVD MOUNTAIN VIEW, CA 94043 | STANDARD INSURANCE COMPANY | $216K | $87K | $303K | 4.20% |
| VITA INSURANCE ASSOCIATES, INC.3 | 900 N. SHORELINE BLVD MOUNTAIN VIEW, CA 94043 | STANDARD INSURANCE COMPANY | $50K | $26K | $77K | 4.58% |
| VITA INSURANCE ASSOCIATES, INC.3 | 900 N. SHORELINE BLVD MOUNTAIN VIEW, CA 94043 | STANDARD INSURANCE COMPANY | $31K | $19K | $50K | 4.81% |
| AGIS NETWORK INC3 | 2122 KRATKY RD ST LOUIS, MO 63114 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $84K | — | $84K | 9.97% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX, INC EIN 33-0441200 PHARMACY BENEFIT MANAGMNT | Float revenue; Claims processing; Direct payment from the plan; Other fees Service code 12 | — | $5.6M |
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $775K |
| METROPOLITAN LIFE INSURANCE COMPANY EIN 13-5581829 CLAIMS PROCESSOR | Claims processing; Contract Administrator Service code 12 | — | $115K |
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 | 1,559 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 28 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 128 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,715 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNITEDHEALTHCARE OF CALIFORNIA | 60 | $454K |
| Vision | VISION SERVICE PLAN | 1,511 | $102K |
| Life insurance | STANDARD INSURANCE COMPANY | 1,559 | $1.0M |
| Short-term disability | STANDARD INSURANCE COMPANY | 1,559 | $1.7M |
| Long-term disability | STANDARD INSURANCE COMPANY | 1,559 | $7.2M |
| Prescription drug(2 contracts, 2 carriers) | UNITEDHEALTHCARE OF CALIFORNIA | 60 | $436K |
| Stop-loss / reinsurancereinsurance | WESTPORT INSURANCE CORPORATION | 1,508 | $1.0M |
| Other(3 contracts, 3 carriers) | STANDARD INSURANCE COMPANY | 1,707 | $1.9M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,707 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.