| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FILICE INSURANCE AGENCY3 Filed as: RON FILICE ENTERPRISES, INC | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $26K | — | $26K | 4.47% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 452632886 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $12K | — | $12K | 2.00% |
| FILICE INSURANCE AGENCY3 | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | KAISER FOUNDATION HEALTH PLAN INC. | $10K | — | $10K | 2.88% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | 160 W. SANTA CLARA ST., SUITE 450 SAN JOSE, CA 951131762 | KAISER FOUNDATION HEALTH PLAN INC. | $7K | — | $7K | 1.96% |
| FILICE INSURANCE AGENCY3 | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | KAISER FOUNDATION HEALTH PLAN INC. | $7K | — | $7K | 3.34% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | 160 W. SANTA CLARA ST., STE 450 SAN JOSE, CA 951131762 | KAISER FOUNDATION HEALTH PLAN INC. | $4K | — | $4K | 1.87% |
| FILICE INSURANCE AGENCY3 Filed as: RON FILICE ENTERPRISES, INC | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | AETNA LIFE INSURANCE CO. | $13K | — | $13K | 6.06% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 452632886 | AETNA LIFE INSURANCE CO. | $8K | — | $8K | 3.67% |
| FILICE INSURANCE AGENCY3 Filed as: RON FILICE ENTERPRISES, INC | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $7K | — | $7K | 9.43% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | PO BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | $961 | $5K | 6.93% |
| FILICE INSURANCE AGENCY3 Filed as: RON FILICE ENTERPRISES | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | VISION SERVICE PLAN | $2K | — | $2K | 6.96% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 452632886 | VISION SERVICE PLAN | $621 | — | $621 | 2.54% |
| FILICE INSURANCE AGENCY3 Filed as: RON FILICE ENTERPRISES, INC | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $956 | — | $956 | 8.68% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE | PO BOX 632886 CINCINNATI, OH 45263 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $696 | $181 | $877 | 7.96% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH & LIFE INSURANCE CO. EIN 59-1031071 CONTRACT ADMINISTATOR | Non-monetary compensation; Float revenue; Participant communication; Named fiduciary; Contract Administrator; Direct payment from the plan; Claims processing; Other services Service code 12 | — | $21K |
| CBIZ BENEFITS & INSURANCE SERVICES BROKER | Insurance agents and brokers Service code 22 | 160 W. SANTA CLARA STREET, STE 450 SAN JOSE, CA 95113 | $0 |
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 | 245 | 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) | 245 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 192 | $1.1M |
| Dental | AETNA LIFE INSURANCE CO. | 434 | $208K |
| Vision | VISION SERVICE PLAN | 173 | $24K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 245 | $71K |
| Other(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 245 | $82K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 434 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.