| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FILICE INSURANCE AGENCY3 Filed as: RON FLICE ENTERPRISES INC | 1762 TECHNOLOGY DRIVE STE 126 SAN JOSE, CA 95110 | REGENCE BLUECROSS BLUESHIELD | $21K | — | $21K | 1.03% |
| DAVIDSON BENEFITS PLANNING LLC3 | 7632 SW DURHAM RD STE 115 TIGARD, OR 97224 | REGENCE BLUECROSS BLUESHIELD | $4K | — | $4K | 0.20% |
| FILICE INSURANCE AGENCY3 Filed as: RON FILICE ENTERPRISES INC | 738 N 1ST ST STE 202 SAN JOSE, CA 95112 | SUN LIFE ASSURANCE COMPANY OF CANADA | $3K | — | $3K | 9.28% |
| DAVIDSON BENEFITS PLANNING LLC3 | 7632 SW DURHAM RD STE 115 TIGARD, OR 97224 | SUN LIFE ASSURANCE COMPANY OF CANADA | $979 | — | $979 | 2.72% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PACIFIC SOURCE ADMINISTRATORS INC EIN 30-0140934 CONTRACT ADMINISTRATORS | Claims processing; Contract Administrator Service code 12 | — | $3K |
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 | 136 | 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) | 136 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | REGENCE BLUECROSS BLUESHIELD | 347 | $2.1M |
| Dental | REGENCE BLUECROSS BLUESHIELD | 347 | $2.1M |
| Vision | REGENCE BLUECROSS BLUESHIELD | 347 | $2.1M |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 179 | $36K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 179 | $36K |
| Prescription drug | REGENCE BLUECROSS BLUESHIELD | 347 | $2.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 347 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.