| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FILICE INSURANCE AGENCY3 | 738 N FIRST ST., STE 202 SAN JOSE, CA 95112 | KAISER FOUNDATION HEALTH PLAN INC. | $26K | $2 | $26K | 1.86% |
| NONE | — | DELTA DENTAL OF CALIFORNIA | — | — | $0 | 0.00% |
| FILICE INSURANCE AGENCY3 | 738 N FIRST ST., STE 202 SAN JOSE, CA 95112 | KAISER FOUNDATION HEALTH PLAN INC. | $5K | — | $5K | 1.86% |
| NONE | — | UNITED HEALTHCARE INSURANCE COMPANY | — | — | $0 | 0.00% |
| NONE | — | UNITED HEALTHCARE INSURANCE COMPANY | — | — | $0 | 0.00% |
| PATRICK CUMMINGS3 | — | VISION SERVICE PLAN | $4K | — | $4K | 10.00% |
| NONE | — | UNITED HEALTHCARE OF CALIFORNIA | — | — | $0 | 0.00% |
| MCGEE & THIELEN INSURANCE BROKERS3 Filed as: MCGEE THIELEN INS. BROKERS INC. | 3840 ROSIN CT #245 SACRAMENTO, CA 95834 | STANDARD INSURANCE COMPANY | $3K | — | $3K | 10.00% |
| MCGEE & THIELEN INSURANCE BROKERS3 Filed as: MCGEE THIELEN INS. BROKERS INC. | 3840 ROSIN CT #245 SACRAMENTO, CA 95834 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 7.32% |
| AGIA3 | 1155 EUGENIA PLACE CARPINTERIA, CA 930132013 | NEW YORK LIFE INSURANCE COMPANY | $1K | $878 | $2K | 9.00% |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 140 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 140 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 209 | $1.8M |
| Dental | DELTA DENTAL OF CALIFORNIA | 391 | $260K |
| Vision | VISION SERVICE PLAN | 206 | $38K |
| Life insurance(2 contracts, 2 carriers) | STANDARD INSURANCE COMPANY | 234 | $48K |
| Long-term disability | STANDARD INSURANCE COMPANY | 48 | $32K |
| Prescription drug | UNITED HEALTHCARE INSURANCE COMPANY | 36 | $177K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 391 | — |
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."
No prospect flags tripped on this filing.