| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| VITA INSURANCE ASSOCIATES, INC.3 Filed as: VITA INSURANCE ASSOCIATES INC | 1451 GRANT ROAD SUITE 200 MOUNTAIN VIEW, CA 94040 | KAISER FOUNDATION HEALTH PLAN INC | $19K | $5 | $19K | 4.98% |
| VITA INSURANCE ASSOCIATES, INC.3 | 1451 GRANT ROAD SUITE 200 MOUNTAIN VIEW, CA 94040 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $16K | $5K | $21K | 23.73% |
| VITA INSURANCE ASSOCIATES, INC.3 Filed as: VITA INSURANCE ASSOCIATES INC | 1451 GRANT ROAD SUITE 200 MOUNTAIN VIEW, CA 94040 | VISION SERVICE PLAN | $1K | — | $1K | 5.24% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| VITA INSURANCE ASSOCIATES, INC. BROKER | Insurance agents and brokers Service code 22 | 1451 GRANT ROAD SUITE 200 MOUNTAIN VIEW, CA 94040 | $35K |
| CIGNA HEALTH & LIFE INS COMPANY | Claims processing; Direct payment from the plan; Float revenue; Named fiduciary; Other services; Contract Administrator; Participant communication; Non-monetary compensation Service code 12 | — | $0 |
| CIGNA HEALTH AND LIFE INS COMPANY EIN 59-1031071 TPA | Other services; Contract Administrator; Participant communication; Direct payment from the plan; Claims processing Service code 12 | — | -$38K |
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 | 150 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 5 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 156 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 52 | $372K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 152 | $87K |
| Vision | VISION SERVICE PLAN | 137 | $23K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 152 | $87K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 152 | $87K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 152 | $87K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 52 | $372K |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 152 | $87K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 152 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.