| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| VITA INSURANCE ASSOCIATES, INC.3 Filed as: VITA INSURANCE ASSOCIATES INC. | 900 N. SHORELINE BLVD MOUNTAIN VIEW, CA 94043 | BLUE SHIELD OF CALIFORNIA | $52K | $0 | $52K | 5.00% |
| VITA INSURANCE ASSOCIATES, INC.3 Filed as: VITA INSURANCE ASSOCIATES INC. | 900 N SHORELINE BLVD MOUNTAIN VIEW, CA 94043 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $40K | — | $40K | 5.00% |
| VITA INSURANCE ASSOCIATES, INC.3 Filed as: VITA INSURANCE ASSOCIATES INC. | 900 NORTH SHORELINE BLVD. MOUNTAIN VIEW, CA 94043 | DELTA DENTAL OF CALIFORNIA | $8K | — | $8K | 5.00% |
| VITA INSURANCE ASSOCIATES, INC.3 | 900 NORTH SHORELINE BLVD MOUNTAIN VIEW, CA 94043 | SUN LIFE ASSURANCE COMPANY OF CANADA | $12K | — | $12K | 11.27% |
| VITA INSURANCE ASSOCIATES, INC.3 | 900 N. SHORELINE BLVD. MOUNTAIN VIEW, CA 94043 | VISION SERVICE PLAN | $2K | — | $2K | 4.32% |
| VITA INSURANCE ASSOCIATES, INC.3 Filed as: VITA INSURANCE ASSOCIATES INC. | 900 N SHORELINE BLVD MOUNTAIN VIEW, CA 94043 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $163 | $84 | $247 | 30.31% |
| PACIFIC ADVISORS LLC0 Filed as: PACIFIC ADVISORS INC | 333 N INDIAN HILL BLVD CLAREMONT, CA 91711 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3 | $0 | $3 | 0.37% |
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 | 141 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 143 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE SHIELD OF CALIFORNIA | 154 | $1.8M |
| Dental | DELTA DENTAL OF CALIFORNIA | 139 | $154K |
| Vision | VISION SERVICE PLAN | 156 | $36K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 152 | $111K |
| Short-term disability(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 152 | $111K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 152 | $111K |
| Prescription drug(2 contracts, 2 carriers) | BLUE SHIELD OF CALIFORNIA | 154 | $1.8M |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 152 | $111K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 156 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.