| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E HAMILTON AVE, SUITE 500 CAMPBELL, CA 95008 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $77K | $30K | $107K | 14.58% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E HAMILTON AVE, SUITE 500 CAMPBELL, CA 95008 | KAISER FOUNDATION HEALTH PLAN INC | $26K | $1 | $26K | 4.99% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E HAMILTON AVE, SUITE 500 CAMPBELL, CA 95008 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $25K | — | $25K | 10.00% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $23 | $23 | 0.01% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E HAMILTON AVE, SUITE 500 CAMPBELL, CA 95008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 15.00% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E HAMILTON AVE, SUITE 500 CAMPBELL, CA 95008 | VISION SERVICE PLAN | $3K | — | $3K | 10.00% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E HAMILTON AVE, SUITE 500 CAMPBELL, CA 95008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 14.94% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E HAMILTON AVE, SUITE 500 CAMPBELL, CA 95008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $592 | — | $592 | 15.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INS COMPANY EIN 59-1031071 CONTRACT ADMINISTRATOR | Float revenue; Claims processing; Non-monetary compensation; Direct payment from the plan; Participant communication; Other services; Contract Administrator Service code 12 | — | $46K |
| DIRECT DENTAL ADMINISTRATORS, LLC EIN 94-3270798 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 7510 SHORELINE DRIVE STOCKTON, CA 95219 | $22K |
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 | 135 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | 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 | 75 | $1.2M |
| Vision | VISION SERVICE PLAN | 130 | $30K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 135 | $248K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 135 | $248K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 135 | $248K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 75 | $518K |
| Other(4 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 135 | $311K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 135 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.