| 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. | $16K | $2 | $16K | 2.19% |
| FILICE INSURANCE AGENCY3 | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $6K | — | $6K | 1.02% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | $3K | $10K | 14.59% |
| FILICE INSURANCE AGENCY3 | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH & LIFE INS. CO. EIN 59-1031071 CONTRACT ADMINISTRATOR | Participant communication; Other services; Claims processing; Contract Administrator; Direct payment from the plan Service code 12 | — | $30K |
| PENSION DYNAMICS COMPANY, LLC EIN 94-2692944 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing; Direct payment from the plan; Participant communication; Other services Service code 12 | 2300 CONTRA COSTA BLVD. PLEASANT HILL, CA 945233987 | $6K |
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 | 159 | 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) | 159 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 148 | $1.3M |
| Dental | DIRECT DENTAL ADMINISTRATORS, LLC | 153 | $11K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 144 | $20K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 159 | $71K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 159 | $71K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN, INC. | 148 | $723K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 159 | $71K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 159 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.