| 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. | $14K | $809 | $15K | 1.94% |
| FILICE INSURANCE AGENCY3 | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $43K | — | $43K | 5.95% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $17K | $17K | 2.38% |
| 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 | $8K | $6K | $13K | 16.93% |
| FILICE INSURANCE AGENCY3 | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $3K | — | $3K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MARIN BENEFITS, INC. EIN 94-1337628 CONTRACT ADMINISTRATOR | Participant communication; Other services; Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.); Copying and duplicating; Claims processing; Contract Administrator Service code 12 | 6366 COMMERCE BLVD. #293 ROHNERT PARK, CA 94928 | $6K |
| CIGNA HEALTH & LIFE INS. CO. EIN 59-1031071 CONTRACT ADMINISTRATOR | Participant communication; Direct payment from the plan; Claims processing; Contract Administrator; Other services Service code 12 | — | $5K |
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 | 166 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 168 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 154 | $1.5M |
| Dental | DIRECT DENTAL ADMINISTRATORS, LLC | 166 | $11K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 155 | $25K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 175 | $80K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 175 | $80K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN, INC. | 154 | $756K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 175 | $80K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 175 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.