| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PROGRESSIVE BENEFIT GROUP3 | 9035 SOQUEL AVE., #200 SANTA CRUZ, CA 95062 | KAISER FOUNDATION HEALTH PLAN INC. | $41K | $0 | $41K | 3.01% |
| PROGRESSIVE BENEFIT GROUP3 | 9035 SOQUEL AVE., #200 SANTA CRUZ, CA 95062 | BLUE CROSS BLUE SHIELD OF FLORIDA | $45K | $0 | $45K | 3.67% |
| PROGRESSIVE BENEFIT GROUP3 | 9035 SOQUEL AVE., #200 SANTA CRUZ, CA 95062 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $9K | $0 | $9K | 7.61% |
| FILICE INSURANCE AGENCY3 Filed as: RON FILICE ENTERPRISES INC | 738 N 1ST ST STE 202 SAN JOSE, CA 95112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $0 | $4K | 2.93% |
| FILICE INSURANCE AGENCY3 Filed as: RON FILICE ENTERPRISES INC | 738 N 1ST ST STE 202 SAN JOSE, CA 95112 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 6.69% |
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 | 267 | 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. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 267 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 196 | $2.6M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 263 | $27K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 263 | $27K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 267 | $124K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 267 | $124K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 267 | $124K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 190 | $1.4M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 267 | $124K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 267 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.