| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| VITA INSURANCE ASSOCIATES, INC.3 Filed as: VITA INSURANCE ASSOCIATES | 1451 GRANT ROAD SUITE 200 MOUNTAIN VIEW, CA 94040 | KAISER FOUNDATION HEALTH PLAN | $21K | $8 | $21K | 2.90% |
| MARYGRACE ELIZONDO3 | — | KAISER FOUNDATION HEALTH PLAN | -$344 | — | -$344 | -0.05% |
| VITA INSURANCE ASSOCIATES, INC.3 | 1451 GRANT ROAD SUITE 200 MOUNTAIN VIEW, CA 94040 | BLUE SHIELD OF CALIFORNIA; CALIFORNIA PHYSICIANS' SERVICE | $16K | — | $16K | 2.57% |
| VITA INSURANCE ASSOCIATES, INC.3 | 1451 GRANT ROAD SUITE 200 MOUNTAIN VIEW, CA 94040 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $11K | — | $11K | 11.75% |
| ENROLLEASE5 | 660 YORK STREET SUITE 102 SAN FRANCISCO, CA 94110 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 2.37% |
| VITA INSURANCE ASSOCIATES, INC.3 Filed as: VITA INSURANCE ASSOCIATES | 1451 GRANT ROAD SUITE 200 MOUNTAIN VIEW, CA 94040 | VISION SERVICE PLAN | $809 | — | $809 | 6.91% |
| MARY GRACE ELIZONDO3 Filed as: MARY GRACE ELIZONDO, CFP | 454 LAS GALLINAS AVENUE SUITE 292 SAN RAFAEL, CA 94903 | VISION SERVICE PLAN | -$2 | — | -$2 | -0.02% |
| MARY GRACE ELIZONDO3 | 454 LAS GALINAS AVE #292 SAN RAFAEL, CA 94903 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $217 | — | $217 | 3.05% |
| LAURA RUNYEON3 | 2042 WEATHERBY WAY PETALUMA, CA 94954 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $213 | — | $213 | 2.99% |
| ALAYNE MATA3 | 3276 KATHY WAY LOOMIS, CA 95650 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $57 | — | $57 | 0.80% |
| DARRYL W VIDOR3 | 3314 EUROPA ST ROSEVILLE, CA 95661 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $49 | — | $49 | 0.69% |
| ANTONIO JOSE ANGELES3 | 1858 ALLISON WAY SAN JOSE, CA 95132 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $41 | — | $41 | 0.58% |
| MARY KOCH3 | 117 WOLF RIVER CT ROSEVILLE, CA 95661 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | — | $9 | 0.13% |
| JOHN D EVANGELISTA3 | 26111 ANTONIO PARKWAY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.03% |
| MICHAEL JAMES LEBRANE3 | 808 EAST 5TH AVE SAN MATEO, CA 94402 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.01% |
| CATHERINE LISA LUKE3 | 4787 W. HACIENDA AVE CAMPBELL, CA 95008 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.01% |
| MIKE MCCORMICK3 | 7 MONSERRAT PL FOOTHILL RANCH, CA 92610 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.01% |
| VITA INSURANCE ASSOCIATES, INC.3 Filed as: VITA INSURANCE ASSOCIATES | 1451 GRANT ROAD SUITE 200 MOUNTAIN VIEW, CA 94040 | CONCERN | $0 | — | $0 | 0.00% |
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 | 128 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 7 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 138 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN | 84 | $1.3M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 130 | $93K |
| Vision | VISION SERVICE PLAN | 73 | $12K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 130 | $93K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 8 | $7K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 130 | $93K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN | 84 | $1.3M |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 163 | $99K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 163 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.