| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EDGEWOOD PARTNERS INSURANCE CENTER3 Filed as: EDGEWOOD PARTNERS INSURANCE | — | HEALTH NET | $27K | — | $27K | 3.32% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | HEALTH NET | $13K | — | $13K | 1.66% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 | 1801 W. OLYMPIC BLVD. PASADENA, CA 91199 | STANDARD INSURANCE COMPANY | $5K | — | $5K | 7.48% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 2.59% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 | EPIC OPERATING FILE 1367 PASADENA, CA 911990001 | VISION SERVICE PLAN | $767 | — | $767 | 4.86% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | VISION SERVICE PLAN | $530 | — | $530 | 3.36% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DIRECT DENTAL ADMINISTRATORS EIN 94-3270798 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $10K |
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 | 101 | 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) | 101 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HEALTH NET | 45 | $1.2M |
| Vision | VISION SERVICE PLAN | 85 | $16K |
| Life insurance | STANDARD INSURANCE COMPANY | 101 | $71K |
| Long-term disability | STANDARD INSURANCE COMPANY | 101 | $71K |
| Prescription drug(2 contracts, 2 carriers) | HEALTH NET | 45 | $1.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 101 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.