| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LEAVITT GROUP3 Filed as: LEAVITT PACIFIC INSURANCE BROKERS | 1570 THE ALAMEDA STE 101 SAN JOSE, CA 92516 | KAISER FOUNDATION HEALTH PLAN INC. | $18K | — | $18K | 4.07% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CALIFORNIA INS | PO BOX 255387 SACRAMENTO, CA 95865 | KAISER FOUNDATION HEALTH PLAN INC. | $4K | — | $4K | 0.91% |
| LEAVITT GROUP3 Filed as: LEAVITT PACIFIC INSURANCE BROKERS | 1570 THE ALAMEDA STE 101 SAN JOSE, CA 95126 | SUN LIFE ASSURANCE COMPANY OF CANADA | $11K | — | $11K | 11.36% |
| LEAVITT GROUP3 Filed as: LEAVITT PACIFIC INSURANCE BROKERS | PO BOX 27020 FRESNO, CA 93711 | WESTERN HEALTH ADVANTAGE | $22K | — | $22K | 100.00% |
| LEAVITT GROUP3 Filed as: LEAVITT PACIFIC INSURANCE BROKERS | 1330 S. BASCOM AVE. SAN JOSE, CA 95128 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 15.00% |
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 | 323 | 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) | 323 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 86 | $475K |
| Dental | SUN LIFE ASSURANCE COMPANY OF CANADA | 323 | $93K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 323 | $93K |
| Long-term disability | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 53 | $8K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 86 | $475K |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 323 | $93K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 323 | — |
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.