| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 NORTH FIRST ST., SUITE 202 SAN JOSE, CA 95112 | KAISER FOUNDATION HEALTH PLAN INC | $34K | — | $34K | 2.49% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | ANTHEM BLUE CROSS | $5K | — | $5K | 3.38% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $848 | — | $848 | 3.44% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MARIN BENEFITS DBA DIRECT DENTAL EIN 94-3270798 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing; Insurance services Service code 12 | 700 LARKSPUR LANDING CIRCLE #199 LARKSPUR, CA 94939 | $17K |
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 | 168 | 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) | 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 | 137 | $1.5M |
| Vision | VISION SERVICE PLAN | 162 | $29K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 168 | $25K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 168 | $25K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 137 | $1.5M |
| Other | RELIANCE STANDARD LIFE INSURANCE COMPANY | 168 | $25K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 168 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.