| 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. | $39K | $509 | $39K | 4.78% |
| FILICE INSURANCE AGENCY3 | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | BLUE SHIELD OF CALIFORNIA | — | $31K | $31K | 5.32% |
| FILICE INSURANCE AGENCY3 | 443 COYOTE CREEK CIRCLE SAN JOSE, CA 95116 | BLUE SHIELD OF CALIFORNIA | — | $18K | $18K | 3.10% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INSURANCE | 6200 CANOGA AVENUE, STE. 300 WOODLAND HILLS, CA 91367 | BLUE SHIELD OF CALIFORNIA | $12K | $489 | $12K | 2.08% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | EYE MED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $2K | — | $2K | 13.45% |
| FILICE INSURANCE AGENCY3 | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | DELTA DENTAL OF CALIFORNIA | $5K | — | $5K | 52.49% |
No Schedule C service providers reported on this filing.
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 | 221 | 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) | 221 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 143 | $1.4M |
| Dental | DELTA DENTAL OF CALIFORNIA | 183 | $9K |
| Vision | EYE MED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 221 | $17K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 143 | $1.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 221 | — |
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.