| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| VITA INSURANCE ASSOCIATES, INC.3 | 1451 GRANT ROAD SUITE 200 MOUNTAIN VIEW, CA 94040 | DELTA DENTAL OF CALIFORNIA | $24K | — | $24K | 2.41% |
| VITA INSURANCE ASSOCIATES, INC.3 | 1451 GRANT ROAD SUITE 200 MOUNTAIN VIEW, CA 94040 | KAISER FOUNDATION HEALTH PLAN INC | $16K | $10 | $16K | 2.00% |
| CHILD HEALTH CORP OF AMERICA3 | 16011 COLLEGE BLVD STE 250 LENEXA, KS 66219 | HARTFORD LIFE AND ACCIDENT | $30K | $517 | $31K | 4.20% |
| MARSH & MCLENNAN AGENCY LLC3 | 2300 RENAISSANCE BLVD KING OF PRUSSIA, PA 19406 | HARTFORD LIFE AND ACCIDENT | — | $27K | $27K | 3.67% |
| VITA INSURANCE ASSOCIATES, INC.3 | 1451 GRANT ROAD STE 200 MOUNTAIN VIEW, CA 94040 | VISION SERVICE PLAN | $5K | — | $5K | 3.19% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $750K |
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 | 1,087 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 37 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,125 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 95 | $823K |
| Dental | DELTA DENTAL OF CALIFORNIA | 1,022 | $1.0M |
| Vision | VISION SERVICE PLAN | 993 | $142K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 1,095 | $735K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 1,095 | $735K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 95 | $823K |
| Stop-loss / reinsurancereinsurance | SWISS RE CORPORATE SOLUTIONS AMERICA INS. CORP. | 922 | $1.0M |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 1,095 | $763K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,095 | — |
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."
No prospect flags tripped on this filing.