| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N FIRST ST., SUITE 202 SAN JOSE, CA 95112 | BLUE CROSS OF CALIFORNIA | $379K | $56K | $435K | 3.88% |
| RSC INSURANCE BROKERAGE INC3 | 160 FEDERAL ST 4TH FLOOR BOSTON, MA 02110 | BLUE CROSS OF CALIFORNIA | $73K | — | $73K | 0.65% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $23K | — | $23K | 3.79% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $16K | — | $16K | 2.55% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | VISION SERVICE PLAN | $3K | — | $3K | 2.39% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | COMBINED INSURANCE COMPANY OF AMERICA | $35K | — | $35K | 30.86% |
| EXPLAIN MY BENEFITS LLC3 Filed as: EXPLAIN MY BENEFITS, LLC | 2461 W. SR 426 SUITE 2021 OVIEDO, FL 32765 | COMBINED INSURANCE COMPANY OF AMERICA | $290 | — | $290 | 0.25% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | COMBINED INSURANCE COMPANY OF AMERICA | $125 | — | $125 | 0.11% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES | 738 N FIRST ST., SUITE 202 SAN JOSE, CA 95112 | TRANSAMERICA LIFE INSURANCE COMPANY | $4K | — | $4K | 4.79% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| STAFF BENEFITS MANAGEMENT, INC. EIN 81-1242192 TPA | Plan Administrator Service code 14 | — | $9K |
| COMPSYCH EIN 35-3739783 THIRD PARTY ADMIN | Claims processing; Contract Administrator Service code 12 | — | $0 |
| PRUDENTIAL INS. CO. AMERICA EIN 22-1211670 THIRD PARTY ADMIN | Contract Administrator; 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 | 1,020 | 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) | 1,020 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 1,791 | $12.1M |
| Dental | BLUE CROSS OF CALIFORNIA | 1,791 | $11.2M |
| Vision | VISION SERVICE PLAN | 790 | $121K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,029 | $619K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,029 | $619K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,029 | $619K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 154 | $815K |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,029 | $733K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,791 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.