| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FILICE INSURANCE AGENCY3 Filed as: RON FILICE ENTERPRISES, INC | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $58K | $3K | $61K | 9.51% |
| FILICE INSURANCE AGENCY3 | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | KAISER FOUNDATION HEALTH PLAN INC | -$105 | — | -$105 | -0.03% |
| CASSIDY O'HARA3 Filed as: CASSIDY E. O'HARA | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $11K | — | $11K | 6.66% |
| CASSIDY O'HARA3 Filed as: CASSIDY E O'HARA | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 15.00% |
| FILICE INSURANCE AGENCY3 Filed as: RON FILICE ENTERPRISES | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | VISION SERVICE PLAN | $3K | — | $3K | 10.00% |
| FILICE INSURANCE AGENCY3 Filed as: RON FILICE ENTERPRISES, INC | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $341 | $3K | 17.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 SERVICE PROVIDER | Contract Administrator Service code 13 | — | $18K |
| DIRECT DENTAL ADMINISTRATORS, LLC EIN 94-3270798 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 700 LARKSPUR LANDING CIRCLE, #199 LARKSPUR, CA 94939 | $14K |
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 | 137 | 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) | 137 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 114 | $1.0M |
| Vision | VISION SERVICE PLAN | 114 | $25K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 137 | $166K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 137 | $166K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 137 | $166K |
| Other(3 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 137 | $223K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 137 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.