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| Provider | Services | Address | Compensation |
|---|---|---|---|
| VITA INSURANCE ASSOCIATES, INC. EIN 94-2595918 BROKER | Insurance agents and brokers Service code 22 | — | $44K |
| CIGNA HEALTH AND LIFE INS COMPANY EIN 59-1031071 TPA | Participant communication; Contract Administrator; Direct payment from the plan; Other services; Float revenue; Named fiduciary; Claims processing; Non-monetary compensation Service code 12 | — | $41K |
| CIGNA LIFE AND HEALTH INS COMPANY | Claims processing; Direct payment from the plan; Named fiduciary; Float revenue; Participant communication; Other services; Non-monetary compensation; Contract Administrator Service code 12 | — | $0 |
| CIGNA LIFE AND HEALTH INS. COMPANY | Non-monetary compensation; Claims processing; Other services; Named fiduciary; Direct payment from the plan; Contract Administrator; Participant communication; Float revenue Service code 12 | — | $0 |
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 | 126 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 8 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 134 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN, INC. | 72 | $360K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 129 | $316K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 129 | $316K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 129 | $316K |
| Short-term disability(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 129 | $318K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 129 | $316K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN, INC. | 72 | $360K |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 129 | $318K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 129 | — |
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.