| 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 | CHINESE COMMUNITY HEALTH PLAN | $12K | — | $12K | 1.92% |
| WELLSON CHEUNG3 | 1668 EL CAMINO REAL SAN CARLOS, CA 94070 | CHINESE COMMUNITY HEALTH PLAN | $12K | — | $12K | 1.91% |
| ROBERT C. PLACAK & ASSOC. INC.3 Filed as: ROBERT C. PLACAK & ASSO, INC | 790 MISSION AVENUE SAN RAFAEL, CA 94901 | CHINESE COMMUNITY HEALTH PLAN | $5K | — | $5K | 0.82% |
| EDDY M TSE3 | 1668 EL CAMINO REAL SAN CARLOS, CA 94070 | CHINESE COMMUNITY HEALTH PLAN | $2K | — | $2K | 0.35% |
| WELLSON CHEUNG3 | 1668 EL CAMINO REAL SAN CARLOS, CA 940705208 | KAISER FOUNDATION HEALTH PLAN INC. | $4K | — | $4K | 2.10% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | KAISER FOUNDATION HEALTH PLAN INC. | $2K | — | $2K | 1.31% |
| ROBERT C PLACAK & ASSOCIATES3 Filed as: ROBERT C. PLACAK & ASSOCIATES, INC | 790 MISSION AVE SAN RAFAEL, CA 949013207 | KAISER FOUNDATION HEALTH PLAN INC. | $2K | — | $2K | 1.11% |
| EDDY M TSE3 Filed as: EDDY TSE | 1668 EL CAMINO REAL SAN CARLOS, CA 940705208 | KAISER FOUNDATION HEALTH PLAN INC. | $485 | — | $485 | 0.28% |
| WELLSON CHEUNG3 Filed as: WELLSON WAI-SANG CHEUNG | 1668 EL CAMINO REAL SAN CARLOS, CA 94070 | HEALTH NET | $987 | $6 | $993 | 2.83% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | HEALTH NET | $930 | $29 | $959 | 2.73% |
| ROBERT C PLACAK & ASSOCIATES3 Filed as: ROBERT C. PLACAK & ASSOCIATES | PERSONAL AND CONFIDENTIAL 790 MISSION AVENUE SAN RAFAEL, CA 94901 | HEALTH NET | $390 | — | $390 | 1.11% |
| EDDY M TSE3 Filed as: EDDY MAN-HO TSE | 1668 EL CAMINO REAL SAN CARLOS, CA 94070 | HEALTH NET | $97 | — | $97 | 0.28% |
| CHEUNG, WELLSON W3 | 1668 EL CAMINO REAL SAN CARLOS, CA 940705208 | UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. | $523 | — | $523 | 8.63% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. | $250 | — | $250 | 4.13% |
| ROBERT C. PLACAK & ASSOC. INC.3 Filed as: ROBERT C PLACAK & ASSOC INC | 790 MISSION AVE SAN RAFAEL, CA 949013207 | UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. | $169 | — | $169 | 2.79% |
| TSE, EDDY M3 | 1668 EL CAMINO REAL SAN CARLOS, CA 940705208 | UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. | $40 | — | $40 | 0.66% |
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 | 129 | 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) | 129 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | CHINESE COMMUNITY HEALTH PLAN | 129 | $816K |
| Dental | UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. | 13 | $6K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 18 | $175K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 129 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.