| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LEAVITT GROUP3 Filed as: LEAVITT PACIFIC INS. BROKERS INC. | 1570 THE ALAMEDA STE 101 SAN JOSE, CA 951262335 | KAISER FOUNDATION HEALTH PLAN, INC. | $13K | — | $13K | 2.93% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 900 E. HAMILTON AVENUE STE 500 CAMPBELL, CA 950080667 | KAISER FOUNDATION HEALTH PLAN, INC. | — | $191 | $191 | 0.04% |
| LEAVITT GROUP3 Filed as: LEAVITT PACIFIC INS. BROKERS INC. | 1570 THE ALAMEDA STE 101 SAN JOSE, CA 951262335 | PRINCIPAL LIFE INSURANCE COMPANY | $6K | — | $6K | 10.24% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INS. SERVICES INC. | 32110 AGOURA RD. WESTLAKE VILLAGE, CA 913614026 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | $2K | $5K | 7.80% |
| LEAVITT GROUP3 Filed as: LEAVITT GROUP AGENCY ASSOC. LLC | PO BOX 130 CEDAR CITY, UT 847210135 | PRINCIPAL LIFE INSURANCE COMPANY | — | $2K | $2K | 2.94% |
| LEAVITT GROUP3 Filed as: LEAVITT PACIFIC INS. BROKERS INC. | 1570 THE ALAMEDA SAN JOSE, CA 951262335 | UNITEDHEALTHCARE INSURANCE COMPANY | $2K | — | $2K | 6.43% |
| VARIOUS - SEE ATTACHED3 Filed as: VARIOUS (SEE ATTACHED) | PO BOX 1365 COLUMBIA, SC 292021365 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $11K | $4K | $16K | 45.32% |
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 | 121 | 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) | 121 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 63 | $476K |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 137 | $63K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 137 | $63K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 137 | $63K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 63 | $476K |
| Other(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 137 | $98K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 137 | — |
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.