| 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 | $28K | $4 | $28K | 2.10% |
| VITA INSURANCE ASSOCIATES, INC.3 | 900 N. SHORELINE BLVD MOUNTAIN VIEW, CA 94043 | SUN LIFE ASSURANCE COMPANY OF CANADA | $51K | — | $51K | 7.63% |
| MGIS5 | 111 SOUTH MAIN STREET, SUITE 400 SALT LAKE CITY, UT 84111 | SUN LIFE ASSURANCE COMPANY OF CANADA | $0 | $180 | $180 | 0.03% |
| VITA INSURANCE ASSOCIATES, INC.3 | 900 N SHORELINE BLVD MOUNTAIN VIEW, CA 94043 | VISION SERVICE PLAN | $4K | — | $4K | 2.71% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $671K |
| METROPOLITAN LIFE INSURANCE COMPANY EIN 13-5581829 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $84K |
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 | 1,069 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | 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) | 1,070 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 179 | $1.3M |
| Vision | VISION SERVICE PLAN | 979 | $158K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,068 | $675K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,068 | $675K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 179 | $1.3M |
| Stop-loss / reinsurancereinsurance | WESTPORT INSURANCE CORPORATION | 838 | $828K |
| Other | MANAGED HEALTH NETWORK | 1,049 | $27K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,068 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.