| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | ANTHEM BLUE CROSS LIFE & HEALTH INSURANCE COMPANY | $68K | — | $68K | 5.07% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | KAISER FOUNDATION HEALTH PLANS INC | $38K | — | $38K | 4.49% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | KAISER FOUNDATION HEALTH PLAN OF HAWAII | $4K | — | $4K | 1.98% |
| 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 | $6K | $13K | 10.11% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | VISION SERVICE PLAN | $1K | — | $1K | 4.31% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM BLUE CROSS LIFE & HEALTH EIN 95-4331852 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing; Float revenue; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $20K |
| MARIN BENEFITS EIN 94-3270798 CLAIMS PROCESSING | Contract Administrator; Claims processing Service code 12 | — | $14K |
| NAVIA BENEFIT SOLUTIONS EIN 77-0252693 CLAIMS PROCESSING | Claims processing Service code 12 | — | $4K |
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 | 401 | 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) | 401 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | ANTHEM BLUE CROSS LIFE & HEALTH INSURANCE COMPANY | 186 | $2.8M |
| Dental(2 contracts, 2 carriers) | CIGNA HEALTH & LIFE INSURANCE COMPANY | 289 | $237K |
| Vision | VISION SERVICE PLAN | 239 | $28K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 401 | $128K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 401 | $128K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLANS INC | 110 | $1.0M |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 401 | $141K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 401 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.