| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | UNITED HEALTHCARE INSURANCE COMPANY | $93K | $13K | $106K | 3.29% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $58K | — | $58K | 4.55% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | UNION SECURITY INSURANCE COMPANY | $7K | — | $7K | 1.28% |
| FILICE INSURANCE AGENCY3 | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | KAISER FOUNDATION HEALTH PLANS, INC. | $15K | — | $15K | 4.23% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | SUN LIFE ASSURANCE COMPANY OF CANADA | $13K | — | $13K | 4.63% |
| FILICE INSURANCE AGENCY3 | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | VISION SERVICE PLAN | $9K | — | $9K | 10.00% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| NAVIA BENEFIT SOLUTIONS EIN 91-1467758 CONTRACT ADMINISTRATION | Claims processing Service code 12 | — | $11K |
| SUN LIFE ASSURANCE EIN 38-1082080 CONTRACT ADMINISTRATION | Contract Administrator; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $7K |
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 | 516 | 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) | 516 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | UNITED HEALTHCARE INSURANCE COMPANY | 810 | $4.9M |
| Dental | UNION SECURITY INSURANCE COMPANY | 448 | $542K |
| Vision | VISION SERVICE PLAN | 449 | $89K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 516 | $289K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 516 | $289K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 516 | $289K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 265 | $1.6M |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 516 | $310K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 810 | — |
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.