| 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 | $165K | $189 | $166K | 2.71% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | CALIFORNIA PHYSICIANS SERVICE | -$36 | — | -$36 | -0.00% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N FIRST ST., SUITE 202 SAN JOSE, CA 95112 | AETNA LIFE INSURANCE COMPANY | $31K | — | $31K | 2.94% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $32K | — | $32K | 4.60% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | VISION SERVICE PLAN | $4K | — | $4K | 2.13% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMPPSYCH EIN 22-1211670 THIRD PARTY ADMIN | Contract Administrator; Claims processing Service code 12 | — | $7K |
| COMPSYCH EIN 35-3739783 THIRD PARTY ADMIN | Claims processing Service code 12 | — | $0 |
| TOTAL ADMINISTRATIVE SERVICES CORP EIN 39-1561025 THIRD PARTY ADMIN | Claims processing; Contract Administrator 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 | 2,147 | 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) | 2,147 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 643 | $9.6M |
| Dental | AETNA LIFE INSURANCE COMPANY | 2,147 | $1.0M |
| Vision | VISION SERVICE PLAN | 947 | $167K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,140 | $698K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,140 | $698K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,140 | $698K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 643 | $9.6M |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,140 | $698K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,147 | — |
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."
No prospect flags tripped on this filing.