| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| VITA INSURANCE ASSOCIATES, INC.3 | 900 N. SHORELINE BLVD MOUNTAIN VIEW, CA 94043 | KAISER FOUNDATION HEALTH PLAN INC | $58K | — | $58K | 2.98% |
| VITA INSURANCE ASSOCIATES, INC.3 | 900 N. SHORELINE BLVD. MOUNTAIN VIEW, CA 94043 | METROPOLITAN LIFE INSURANCE COMPANY | $16K | $6K | $21K | 2.87% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIR CHICAGO, IL 606740045 | METROPOLITAN LIFE INSURANCE COMPANY | -$2K | -$10K | -$12K | -1.61% |
| VITA INSURANCE ASSOCIATES, INC.3 Filed as: VITA INSURANCE ASSOCIATES INC. | 900 N. SHORELINE BLVD. MOUNTAIN VIEW, CA 94043 | SUN LIFE ASSURANCE COMPANY OF CANADA | $30K | — | $30K | 7.55% |
| MEDICAL GROUP INSURANCE SERVICES5 | 1849 WEST NORTH TEMPLE SALT LAKE CITY, UT 84116 | SUN LIFE ASSURANCE COMPANY OF CANADA | $0 | $180 | $180 | 0.04% |
| VITA INSURANCE ASSOCIATES, INC.3 | 900 N. SHORELINE BLVD. MOUNTAIN VIEW, CA 94043 | VISION SERVICE PLAN | $3K | — | $3K | 2.39% |
| VITA INSURANCE ASSOCIATES, INC.3 Filed as: VITA INSURANCE ASSOCIATES INC. | 900 N. SHORELINE BLVD. MOUNTAIN VIEW, CA 94043 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $9K | $275 | $9K | 19.31% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIR CHICAGO, IL 60674 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $0 | -$646 | -$646 | -1.33% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIR CHICAGO, IL 606740001 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | -$677 | — | -$677 | -1.39% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CALIFORNIA PHYSICIANS' SERVICE EIN 94-0360524 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $363K |
| VITA INSURANCE ASSOC INC EIN 94-2595918 INSURANCE BROKER | Insurance agents and brokers Service code 22 | — | $105K |
| ARGUS HEALTH SYSTEMS INC. | Plan Administrator Service code 14 | — | $2K |
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 | 955 | 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. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 955 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 280 | $1.9M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 1,793 | $791K |
| Vision | VISION SERVICE PLAN | 865 | $121K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 953 | $404K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 953 | $404K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 280 | $1.9M |
| Other | MANAGED HEALTH NETWORK, INC. | 500 | $11K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,793 | — |
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.