| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE | 738 N. FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | KAISER FOUNDATION HEALTH PLAN INC. | $21K | $2 | $21K | 2.94% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | 10940 WHITE ROCK ROAD, 2ND FLOOR RANCHO CORDOVA, CA 95670 | KAISER FOUNDATION HEALTH PLAN INC. | $17K | — | $17K | 2.48% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE | 738 N. FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | SUTTER HEALTH PLAN | $5K | — | $5K | 2.88% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | 10940 WHITE ROCK ROAD, 2ND FLOOR RANCHO CORDOVA, CA 95670 | SUTTER HEALTH PLAN | $3K | — | $3K | 2.12% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | 10940 WHITE ROCK ROAD, 2ND FLOOR RANCHO CORDOVA, CA 95670 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | $700 | $3K | 3.59% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE | 738 N. FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | METROPOLITAN LIFE INSURANCE COMPANY | $913 | — | $913 | 1.24% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE | 738 N. FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | EYEMED VISION CARE | $494 | — | $494 | 4.87% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | 10940 WHITE ROCK ROAD, 2ND FLOOR RANCHO CORDOVA, CA 95670 | EYEMED VISION CARE | $440 | — | $440 | 4.33% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA | P.O. BOX 1788 GRAND RAPIDS, MI 49501 | MANAGED HEALTH NETWORK | $113 | — | $113 | 5.01% |
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 | 100 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 101 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 109 | $861K |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 194 | $74K |
| Vision | EYEMED VISION CARE | 177 | $10K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 109 | $861K |
| Other | MANAGED HEALTH NETWORK | 100 | $2K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 194 | — |
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.