| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FILICE INSURANCE AGENCY3 | 738 N FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | KAISER FOUNDATION HEALTH PLAN INC. | $32K | — | $32K | 1.74% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: DBS - ARTHUR J GALLAGHER | 8880 RIO SAN DIEGO DRIVE, SUITE 790 SAN DIEGO, CA 92108 | KAISER FOUNDATION HEALTH PLAN INC. | $3K | — | $3K | 0.15% |
| FILICE INSURANCE AGENCY3 Filed as: RON FILICE ENTERPRISES INC | 738 N 1ST STREET, SUITE 202 SAN JOSE, CA 95112 | METROPOLITAN LIFE INSURANCE COMPANY | $12K | $4K | $17K | 8.33% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: DBS - ARTHUR J GALLAGHER | 8880 RIO SAN DIEGO DRIVE, SUITE 790 SAN DIEGO, CA 92108 | METROPOLITAN LIFE INSURANCE COMPANY | $418 | $539 | $957 | 0.48% |
| FILICE INSURANCE AGENCY3 Filed as: RON FILICE ENTERPRISES INC | 1150 MARAGA WAY MORAGA, CA 94556 | AMERITAS LIFE INSURANCE COMPANY | $388 | — | $388 | 4.65% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: DBS - ARTHUR J GALLAGHER | 8880 RIO SAN DIEGO DRIVE, SUITE 790 SAN DIEGO, CA 92108 | AMERITAS LIFE INSURANCE COMPANY | $61 | — | $61 | 0.73% |
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 | 150 | 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. |
| Total participants (= "Plan participants" tile) | 150 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC. | 258 | $1.8M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 503 | $200K |
| Vision | AMERITAS LIFE INSURANCE COMPANY | 58 | $8K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 503 | $200K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 258 | $1.8M |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 503 | $200K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 503 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.