| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | KAISER FOUNDATION HEALTH PLAN INC | — | $8K | $8K | 0.10% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $7K | $7K | 1.48% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $2K | $2K | 1.50% |
| PANTALONE, JO, ANN3 Filed as: PANTALONE, LOUIS, JOSEPH CUSTOM BEN | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $781 | — | $781 | 1.38% |
| USI INSURANCE SERVICES LLC3 | 201 MISSION STREET, SUITE 1100 SAN FRANCISCO, CA 94105 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $497 | — | $497 | 0.88% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $271 | — | $271 | 0.48% |
| AON CONSULTING INC3 Filed as: CUSTOM BENEFIT PROGRAMS AN AON COMP | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.01% |
| THE AGURS GROUP INC.4 Filed as: THE AGURS GROUP, INC | 5721 FRENCH LACE CT NORTH LAS VEGAS, NV 89081 | PRE-PAID LEGAL SERVICES, INC DBA LEGALSHIELD | $5K | — | $5K | 11.98% |
| LINDA J. CASH4 Filed as: LINDA JOY CASH | 3430 TULLY RD, SUITE 20-426 MODESTO, CA 95350 | PRE-PAID LEGAL SERVICES, INC DBA LEGALSHIELD | $423 | — | $423 | 1.12% |
| GRACE S. COTA4 | 7342 PATERO CIRCLE SACRAMENTO, CA 95823 | PRE-PAID LEGAL SERVICES, INC DBA LEGALSHIELD | $406 | — | $406 | 1.07% |
| KATHLEEN R. GONZALES4 | 5721 FRENCH LACE CT NORTH LAS VEGAS, NV 89081 | PRE-PAID LEGAL SERVICES, INC DBA LEGALSHIELD | $252 | — | $252 | 0.66% |
| TERESA K. DURRANT4 | 1256 FRED JACKSON WAY RICHMOND, CA 94801 | PRE-PAID LEGAL SERVICES, INC DBA LEGALSHIELD | $103 | — | $103 | 0.27% |
| CHRISTINE WALKER4 | 591 DREW VIEW LN SAN DIEGO, CA 92113 | PRE-PAID LEGAL SERVICES, INC DBA LEGALSHIELD | $89 | — | $89 | 0.23% |
| MARIA GALICIA4 | 3601 NIGHTINGALE DR ANTIOCH, CA 94509 | PRE-PAID LEGAL SERVICES, INC DBA LEGALSHIELD | $78 | — | $78 | 0.21% |
| JEREMY A. GOMEZ4 | 43805 MONTEREY AVE, APT 24 PALM DESERT, CA 92260 | PRE-PAID LEGAL SERVICES, INC DBA LEGALSHIELD | $48 | — | $48 | 0.13% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM EIN 84-0747736 NETWORK PROVIDER | Claims processing; Other services; Contract Administrator Service code 12 | — | $66K |
| LUCENT HEALTH EIN 39-1997579 THIRD PARTY ADMIN | Claims processing; Contract Administrator Service code 12 | — | $62K |
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 | 1,590 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 29 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,619 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 1,477 | $13.1M |
| Dental(6 contracts) | DELTA DENTAL OF CALIFORNIA | 1,924 | $97K |
| Vision | VISION SERVICE PLAN | 1,414 | $212K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,544 | $495K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,544 | $495K |
| Prescription drug | SUTTER HEALTH PLAN | 876 | $4.9M |
| Stop-loss / reinsurancereinsurance | GERBER LIFE INSURANCE COMPANY | 253 | $755K |
| Other(4 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,544 | $733K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,924 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.