| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LEAVITT GROUP3 Filed as: LEAVITT PACIFIC INS. BROKERS INC. | 1570 THE ALAMEDA SUITE 101 SAN JOSE, CA 95126 | KAISER FOUNDATION HEALTH PLAN INC | $21K | — | $21K | 5.39% |
| LEAVITT GROUP3 Filed as: LEAVITT PACIFIC INSURANCE BROKERS | 1570 THE ALAMEDA SUITE 101 SAN JOSE, CA 95126 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $7K | — | $7K | 3.56% |
| LEAVITT GROUP3 Filed as: LEAVITT PACIFIC INSURANCE BROKERS | 1570 THE ALAMEDA SUITE 101 SAN JOSE, CA 95126 | PRINCIPAL LIFE INSURANCE COMPANY | $8K | — | $8K | 10.02% |
| GA SOLUTIONS LLC3 | 311 CLOCK TOWER CMNS BREWSTER, NY 10509 | PRINCIPAL LIFE INSURANCE COMPANY | — | $4K | $4K | 4.17% |
| LEAVITT GROUP3 Filed as: LEAVITT GROUP AGENCY ASSOCIATION | PO BOX 130 CEDAR CITY, UT 84721 | PRINCIPAL LIFE INSURANCE COMPANY | — | $437 | $437 | 0.52% |
| VARIOUS - SEE ATTACHED3 Filed as: VARIOUS SEE ATTACHED SCHEDULE | PO BOX 1365 COLUMBIA, SC 29202 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16K | $7K | $23K | 62.35% |
| LEAVITT GROUP3 Filed as: LEAVITT PACIFIC INSURANCE BROKERS | 1330 S. BASCOM AVE. SAN JOSE, CA 95128 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $119 | — | $119 | 9.98% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $60 | — | $60 | 5.03% |
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 | 133 | 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) | 133 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 44 | $599K |
| Dental(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 161 | $86K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 161 | $85K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 161 | $85K |
| Other(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 161 | $121K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 161 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.