| 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 | $228K | $303 | $228K | 2.14% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N FIRST ST., SUITE 202 SAN JOSE, CA 95112 | AETNA LIFE INSURANCE COMPANY | $37K | — | $37K | 2.88% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $38K | — | $38K | 8.24% |
| KATHRYN E. BOYD-LITTLE3 | 5110 MARYLAND WAY, SUITE 130 BRENTWOOD, TN 37027 | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | $6K | — | $6K | 7.43% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | BLUECROSS BLUESHIELD OF TENNESSEE, INC. | $896 | — | $896 | 1.19% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | VISION SERVICE PLAN | $4K | — | $4K | 11.04% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PRUDENTIAL INS. CO. AMERICA EIN 22-1211670 THIRD PARTY ADMIN | Claims processing; Contract Administrator Service code 12 | — | $20K |
| COMPSYCH EIN 35-3739783 THIRD PARTY ADMIN | Claims processing; Contract Administrator Service code 12 | — | $18K |
| TOTAL ADMINISTRATIVE SERVICES CORP EIN 39-1561025 THIRD PARTY ADMIN | Contract Administrator Service code 13 | 2302 INTERNATIONAL LANE MADISON, WI 53704 | $16K |
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 | 3,054 | 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) | 3,054 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | CALIFORNIA PHYSICIANS SERVICE | 1,136 | $13.4M |
| Dental | AETNA LIFE INSURANCE COMPANY | 3,054 | $1.3M |
| Vision(2 contracts, 2 carriers) | VISION SERVICE PLAN | 1,165 | $38K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,812 | $456K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,812 | $456K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,812 | $456K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 1,136 | $13.3M |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,812 | $456K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,054 | — |
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.