| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| VITA INSURANCE ASSOCIATES, INC.3 | 900 NORTH SHORELINE BOULEVARD MOUNTAIN VIEW, CA 94043 | KAISER FOUNDATION HEALTH PLANS, INC. | $79K | — | $79K | 4.88% |
| VITA INSURANCE ASSOCIATES, INC.3 | 900 NORTH SHORELINE BOULEVARD MOUNTAIN VIEW, CA 94043 | SUN LIFE ASSURANCE COMPANY OF CANADA | $6K | — | $6K | 1.28% |
| UNITED BENEFITS ADVISORS INC3 | 10 WYNSHIRE LANE RED LION, PA 17356 | SUN LIFE ASSURANCE COMPANY OF CANADA | $1K | — | $1K | 0.23% |
| VITA INSURANCE ASSOCIATES, INC.3 | 900 NORTH SHORELINE BOULEVARD MOUNTAIN VIEW, CA 94043 | SUN LIFE ASSURANCE COMPANY OF CANADA | $7K | — | $7K | 2.79% |
| UNITED BENEFITS ADVISORS INC3 | 10 WYNSHIRE LANE RED LION, PA 17356 | SUN LIFE ASSURANCE COMPANY OF CANADA | $664 | — | $664 | 0.26% |
| VITA INSURANCE ASSOCIATES, INC.3 Filed as: VITA INSURANCE ASSOCIATES INC | 900 NORTH SHORELINE BOULEVARD MOUNTAIN VIEW, CA 94043 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $66K | $7K | $73K | 41.66% |
| VITA INSURANCE ASSOCIATES, INC.3 Filed as: VITA INSURANCE ASSOCIATES | 900 NORTH SHORELINE BLVD MOUNTAIN VIEW, CA 94043 | ACE AMERICAN INSURANCE COMPANY | $6K | — | $6K | 19.71% |
| VITA INSURANCE ASSOCIATES, INC.3 Filed as: VITA INSURANCE ASSOCIATES INC | 900 NORTH SHORELINE BLVD MOUNTAIN VIEW, CA 94043 | SUN LIFE ASSURANCE COMPANY OF CANADA | $295 | — | $295 | 8.01% |
| VITA INSURANCE ASSOCIATES, INC.3 Filed as: VITA INSURANCE ASSOCIATES INC | 900 NORTH SHORELINE BLVD MOUNTAIN VIEW, CA 94043 | SUN LIFE AND HEALTH INSURANCE COMPANY (U.S) | $42 | — | $42 | 9.25% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES, INC. EIN 41-1289245 CLAIMS PROCESSOR | Claims processing; Other services Service code 12 | — | $584K |
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 | 1,564 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 53 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 7 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 1,624 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLANS, INC. | 426 | $1.6M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,553 | $176K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,553 | $176K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,425 | $488K |
| Short-term disability(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 31 | $4K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,425 | $254K |
| Prescription drug | KAISER FOUNDATION HEALTH PLANS, INC. | 426 | $1.6M |
| Stop-loss / reinsurancereinsurance | UNITEDHEALTHCARE INSURANCE COMPANY | 3,286 | $1.1M |
| Other(2 contracts, 2 carriers) | OPTUM HEALTH & TECHNOLOGY (US), LLC | 1,017 | $58K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,286 | — |
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.