| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE COMPANY | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | CALIFORNIA PHYSICIANS SERVICE | $219K | $7K | $226K | 2.88% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | CALIFORNIA PHYSICIANS SERVICE | $5K | — | $5K | 0.07% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N FIRST ST., SUITE 202 SAN JOSE, CA 95112 | AETNA LIFE INSURANCE COMPANY | $35K | $8K | $43K | 3.80% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | AETNA LIFE INSURANCE COMPANY | $7 | $18K | $18K | 1.58% |
| FILICE INSURANCE AGENCY5 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $14K | — | $14K | 1.95% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 0.79% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | VISION SERVICE PLAN | $4K | — | $4K | 2.05% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PRUDENTIAL INSURANCE CO. OF AMERICA EIN 22-1211670 THIRD PARTY ADMIN | Claims processing; Contract Administrator Service code 12 | — | $28K |
| COMPSYCH EIN 35-3739783 THIRD PARTY ADMIN | Claims processing Service code 12 | — | $0 |
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 | 1,430 | 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) | 1,430 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 665 | $12.5M |
| Dental | AETNA LIFE INSURANCE COMPANY | 2,648 | $1.1M |
| Vision | VISION SERVICE PLAN | 1,039 | $189K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,177 | $740K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,177 | $740K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,177 | $740K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 665 | $12.5M |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,177 | $740K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,648 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.