| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FILICE INSURANCE AGENCY3 Filed as: RON FILICE ENTERPRISES, INC | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COPMANY | $71K | $692 | $71K | 5.08% |
| FILICE INSURANCE AGENCY3 | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | KAISER FOUNDATION HEALTH PLAN INC | $19K | — | $19K | 2.75% |
| FILICE INSURANCE AGENCY3 Filed as: RON FILICE ENTERPRISES, INC | 1150 MORAGA WAY MORAGA, CA 94556 | AMERITAS LIFE INSURANCE CORP | $1K | — | $1K | 5.14% |
| FILICE INSURANCE AGENCY3 | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | MES VISION | $428 | — | $428 | 4.92% |
| FILICE INSURANCE AGENCY3 Filed as: RON FILICE ENTERPRISES, INC | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | SUN LIFE ASSURANCE COMPANY OF CANADA | $559 | — | $559 | 10.01% |
| FILICE INSURANCE AGENCY3 Filed as: RON FILICE ENTERPRISES, INC | 1150 MORAGA WAY MORAGA, CA 94556 | AMERITAS LIFE INSURANCE CORP | $249 | — | $249 | 5.18% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM BLUE CROSS LIFE AND HEALTH EIN 95-4331852 CARRIER | Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Contract Administrator; Claims processing Service code 12 | — | $21K |
| RON FILICE ENTERPRISES, INC BROKER | Other commissions; Insurance brokerage commissions and fees; Insurance agents and brokers; Non-monetary compensation Service code 22 | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | $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 | 285 | 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) | 285 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COPMANY | 197 | $2.1M |
| Dental | AMERITAS LIFE INSURANCE CORP | 57 | $26K |
| Vision(2 contracts, 2 carriers) | MES VISION | 106 | $14K |
| Life insurance | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COPMANY | 197 | $1.4M |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 36 | $6K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 197 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.