| 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 INC | — | $602 | $602 | 0.07% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST ST., SUITE 202 SAN JOSEE, CA 95112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $4K | $4K | 5.58% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 23.49% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| TRUSTMARK HEALTH BENEFITS, INC. EIN 35-1846036 NONE | Other services; Plan Administrator; Claims processing Service code 12 | — | $75K |
| FILICE INSURANCE EIN 77-0261203 NONE | Consulting (general); Insurance agents and brokers Service code 16 | — | $44K |
| ANTHEM BLUE CROSS HEALTH INSURANCE EIN 95-4331852 CONTRACT ADMINISTRATOR | Non-monetary compensation; Float revenue; Direct payment from the plan; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Claims processing Service code 12 | — | $24K |
| EMPIRE HEALTHCHOICE ASSURANCE, INC. EIN 23-7391136 NONE | Other services; Claims processing Service code 12 | — | $12K |
| MARIN BENEFITS ADMINISTRATORS EIN 83-2706943 CONTRACT ADMINISTRATOR | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 13 | 6366 COMMERCE BLVD., #293 ROHNERT PARK, CA 94928 | $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 | 191 | 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) | 191 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 163 | $868K |
| Dental(2 contracts) | DELTA DENTAL OF CALIFORNIA | 150 | $25K |
| Vision | VISION SERVICE PLAN | 149 | $23K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 191 | $68K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 191 | $68K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 163 | $868K |
| Other(4 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 191 | $109K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 191 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.