| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LIBERTY COMPANY INSURANCE BROKERS3 Filed as: THE LIBERTY INSURANCE BROKERS | 21820 BURBANK BOULEVARD, SUITE 310 WOODLAND HILLS, CA 91367 | KAISER FOUNDATION HEALTH PLAN INC | $28K | $0 | $28K | 4.00% |
| FILICE INSURANCE AGENCY3 | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | KAISER FOUNDATION HEALTH PLAN INC | $6K | $0 | $6K | 0.83% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS. SERVICES, INC. | PO BOX 632886 CINCINNATI, OH 45263 | HUMANADENTAL INSURANCE COMPANY | $4K | $4K | $8K | 4.37% |
| FILICE INSURANCE AGENCY3 Filed as: RON FILICE ENTERPRISES, INC. | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | HUMANADENTAL INSURANCE COMPANY | $79 | $0 | $79 | 0.05% |
| LIBERTY COMPANY INSURANCE BROKERS3 Filed as: THE LIBERTY COMPANY INS. BROKERS | 2107 NORTH 1ST STREET, SUITE 370 SAN JOSE, CA 95131 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $0 | $4K | 11.28% |
| FILICE INSURANCE AGENCY3 Filed as: RON FILICE ENTERPRISES, INC. | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $0 | $1K | 3.73% |
| LIBERTY COMPANY INSURANCE BROKERS3 Filed as: THE LIBERTY COMPANY INS. BROKERS | 5955 DE SOTO AVENUE, SUITE 250 WOODLAND HILLS, CA 91367 | VISION SERVICE PLAN | $696 | $0 | $696 | 5.62% |
| FILICE INSURANCE AGENCY3 | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | VISION SERVICE PLAN | $316 | $0 | $316 | 2.55% |
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 | 184 | 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) | 184 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 184 | $700K |
| Dental | HUMANADENTAL INSURANCE COMPANY | 182 | $174K |
| Vision | VISION SERVICE PLAN | 98 | $12K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 184 | $33K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 184 | $33K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 184 | $33K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 184 | $700K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 184 | $33K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 184 | — |
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.