| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | KAISER FOUNDATION HEALTH PLAN | $44K | — | $44K | 3.88% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $461 | $2K | 18.41% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $1K | — | $1K | 11.65% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MARIN BENEFITS ADMINISTRATORS EIN 83-2706943 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | 6366 COMMERCE BLVD. #293 ROHNERT PARK, CA 94928 | $10K |
| DIRECT DENTAL ADMINISTRATORS EIN 94-3270798 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | 7510 SHORELINE DRIVE STOCKTON, CA 95219 | $9K |
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 | 190 | 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) | 190 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN | 190 | $1.1M |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 137 | $12K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 141 | $14K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN | 190 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 190 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.